Provider Demographics
NPI:1346699659
Name:COOPER, SAMANTHA (DO)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8440 WALNUT HILL LN STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3814
Mailing Address - Country:US
Mailing Address - Phone:214-328-3566
Mailing Address - Fax:214-328-0798
Practice Address - Street 1:8440 WALNUT HILL LN STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3814
Practice Address - Country:US
Practice Address - Phone:214-328-3566
Practice Address - Fax:214-328-0798
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR5377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine