Provider Demographics
NPI:1326145632
Name:COOPER, KARL ANTHONY (PA-C)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:ANTHONY
Last Name:COOPER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 MOW WAY ROAD
Mailing Address - Street 2:REYNOLDS ARMY COMMUNITY HOSPITAL (ATTN: MCUA-QC)
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503-6300
Mailing Address - Country:US
Mailing Address - Phone:580-458-2134
Mailing Address - Fax:580-458-2314
Practice Address - Street 1:4301 MOW WAY ROAD
Practice Address - Street 2:REYNOLDS ARMY COMMUNITY HOSPITAL (ATTN: MCUA-QC)
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-6300
Practice Address - Country:US
Practice Address - Phone:580-458-2134
Practice Address - Fax:580-458-2314
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK833363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant