Provider Demographics
NPI:1013013267
Name:COOPER, JAMES K II (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:K
Last Name:COOPER
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-3877
Mailing Address - Country:US
Mailing Address - Phone:270-841-7731
Mailing Address - Fax:
Practice Address - Street 1:2821 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-3877
Practice Address - Country:US
Practice Address - Phone:270-841-7731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02544207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000044323OtherBCBS PROVIDER NUMBER
KY02544OtherLICENSE
KY64927379Medicaid
KY0376165Medicare PIN
KY02544OtherLICENSE
F48971Medicare UPIN
KY64927379Medicaid
050070977Medicare PIN