Provider Demographics
NPI:1093912578
Name:COOPER, ROBERT IAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:IAN
Last Name:COOPER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2704 BROADWAY N
Mailing Address - Street 2:SUITE C
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-1487
Mailing Address - Country:US
Mailing Address - Phone:701-237-9400
Mailing Address - Fax:701-232-3135
Practice Address - Street 1:2704 BROADWAY N
Practice Address - Street 2:SUITE C
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-1487
Practice Address - Country:US
Practice Address - Phone:701-237-9400
Practice Address - Fax:701-232-3135
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
ND6519202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND26594Medicare UPIN