Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 027358 | CT |
NPI | 1003860891 |
---|---|
Provider Name | Timothy E Cooper |
First Address | Putnam, CT 06260 |
Second Address | Putnam, CT 06260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 23/08/2011 |