Provider Demographics
NPI:1407548852
Name:COOPER, ABRAHAM FAUSTO JORNADA (DO)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:FAUSTO JORNADA
Last Name:COOPER
Suffix:
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 1:81 MSGS/GME
Mailing Address - Street 2:301 FISHER ST, RM 5A127
Mailing Address - City:KEESLER AFB
Mailing Address - State:MS
Mailing Address - Zip Code:39534
Mailing Address - Country:US
Mailing Address - Phone:214-491-7699
Mailing Address - Fax:
Practice Address - Street 1:81 MSGS/GME
Practice Address - Street 2:301 FISHER ST, RM 5A127
Practice Address - City:KEESLER AFB
Practice Address - State:MS
Practice Address - Zip Code:39534
Practice Address - Country:US
Practice Address - Phone:214-491-7699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program