Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 32474 | CO |
NPI | 1285706788 |
---|---|
Provider Name | Ms. Suzanne S Cooper |
First Address | Centennial, CO 80112 |
Second Address | Centennial, CO 80112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1324748 | (05) | CO |
E49894 | (02) |