Provider Demographics
NPI:1114923182
Name:COOPER, RICHARD E (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 ARROWHEAD BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-7636
Mailing Address - Country:US
Mailing Address - Phone:919-304-1081
Mailing Address - Fax:
Practice Address - Street 1:3940 ARROWHEAD BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-7636
Practice Address - Country:US
Practice Address - Phone:919-304-1081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21435208600000X
NC2010-01962208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ152736Medicaid
F64424Medicare UPIN
20979Medicare ID - Type Unspecified