Provider Demographics
NPI:1134110984
Name:COOPER, CATHY N (MD)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:N
Last Name:COOPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W CENTRAL AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-2184
Mailing Address - Country:US
Mailing Address - Phone:316-321-2010
Mailing Address - Fax:316-321-8871
Practice Address - Street 1:700 W CENTRAL AVE
Practice Address - Street 2:STE 205
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2184
Practice Address - Country:US
Practice Address - Phone:316-321-2010
Practice Address - Fax:316-321-8871
Is Sole Proprietor?:No
Enumeration Date:2005-11-01
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0422611207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100114790AMedicaid
KS100114790AMedicaid
KSE65134Medicare UPIN