Provider Demographics
NPI:1093154023
Name:COOPER, ANDREW D (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:D
Last Name:COOPER
Suffix:
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 1:2635 CHANNING WAY
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7518
Mailing Address - Country:US
Mailing Address - Phone:208-535-4343
Mailing Address - Fax:208-535-4344
Practice Address - Street 1:2635 CHANNING WAY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7518
Practice Address - Country:US
Practice Address - Phone:208-535-4343
Practice Address - Fax:208-535-4344
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-1116208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation