Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 061411 | GA |
N | 2080P0207X | Pediatric Hematology-Oncologist | DO-646 | AL |
NPI | 1205943701 |
---|---|
Provider Name | Todd M Cooper |
First Address | Atlanta, GA 30322-0001 |
Second Address | Birmingham, AL 35233-1711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 12/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009962845 | (05) | AL |
009963675 | (05) | AL |
I17771 | (02) |