Provider Demographics
NPI:1225126469
Name:COOPER, CHRISTIAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:A
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 1:1906 W US HIGHWAY 82
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-6893
Mailing Address - Country:US
Mailing Address - Phone:903-892-8398
Mailing Address - Fax:903-892-6665
Practice Address - Street 1:1906 HWY 82 W
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092
Practice Address - Country:US
Practice Address - Phone:903-892-8398
Practice Address - Fax:903-892-6665
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK67VOtherMEDICARE/BLUESHIELD GROUP
TX80V531Medicare ID - Type Unspecified
TXK67VOtherMEDICARE/BLUESHIELD GROUP