Provider Demographics
NPI:1295829935
Name:COOPER, MAXWELL ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MAXWELL
Middle Name:ALAN
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 1:407 ULUNIU ST STE 313
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2544
Mailing Address - Country:US
Mailing Address - Phone:808-261-8988
Mailing Address - Fax:808-261-2602
Practice Address - Street 1:407 ULUNIU ST STE 313
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2544
Practice Address - Country:US
Practice Address - Phone:808-261-8988
Practice Address - Fax:808-261-2602
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3609174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist