Provider Demographics
NPI:1417310707
Name:PARK COOPER MEDICAL P.A.
Entity Type:Organization
Organization Name:PARK COOPER MEDICAL P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JABEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:682-777-3627
Mailing Address - Street 1:801 W PARK ROW DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-3904
Mailing Address - Country:US
Mailing Address - Phone:682-777-3627
Mailing Address - Fax:
Practice Address - Street 1:801 W PARK ROW DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-3904
Practice Address - Country:US
Practice Address - Phone:682-777-3627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-03
Last Update Date:2016-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2305261Q00000X, 261QP2300X, 261QP3300X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care