Provider Demographics
NPI:1376249284
Name:COOPER FAMILY PRACTICE PLLC
Entity Type:Organization
Organization Name:COOPER FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DURGA
Authorized Official - Middle Name:PRASAD
Authorized Official - Last Name:MEKALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-899-0721
Mailing Address - Street 1:945 DEFOREST RD
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2740
Mailing Address - Country:US
Mailing Address - Phone:469-442-9132
Mailing Address - Fax:
Practice Address - Street 1:3600 S COOPER ST STE 120
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-3406
Practice Address - Country:US
Practice Address - Phone:817-987-1414
Practice Address - Fax:817-987-1425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty