Provider Demographics
NPI:1376603084
Name:COOLEY, ROBERT NELSON JR (DO)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:NELSON
Last Name:COOLEY
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5515 W 81ST TER
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-4957
Mailing Address - Country:US
Mailing Address - Phone:913-649-0880
Mailing Address - Fax:913-328-4603
Practice Address - Street 1:1301 N 47TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-2152
Practice Address - Country:US
Practice Address - Phone:913-328-4609
Practice Address - Fax:913-328-4603
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS30772207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208767905Medicaid
MOHO1445Medicare UPIN