Provider Demographics
NPI:1083991137
Name:COOPER, ED JR (CPT)
Entity Type:Individual
Prefix:
First Name:ED
Middle Name:
Last Name:COOPER
Suffix:JR
Gender:M
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6726 MEADOWCREST DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-3584
Mailing Address - Country:US
Mailing Address - Phone:817-716-7757
Mailing Address - Fax:
Practice Address - Street 1:219 S CEDAR RIDGE DR
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4528
Practice Address - Country:US
Practice Address - Phone:817-716-7757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator