Provider Demographics
NPI:1013209956
Name:R. EDWARD COOPER JR., M.D., P.A.
Entity Type:Organization
Organization Name:R. EDWARD COOPER JR., M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:870-972-8521
Mailing Address - Street 1:1000 E MATTHEWS AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4307
Mailing Address - Country:US
Mailing Address - Phone:870-972-8521
Mailing Address - Fax:870-972-8042
Practice Address - Street 1:1000 E MATTHEWS AVE
Practice Address - Street 2:SUITE D
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4307
Practice Address - Country:US
Practice Address - Phone:870-972-8521
Practice Address - Fax:870-972-8042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8114207X00000X
ARPA- 439363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty