Provider Demographics
NPI:1417941030
Name:COOLEY, JEFFERY S (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:S
Last Name:COOLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-3160
Mailing Address - Country:US
Mailing Address - Phone:413-586-8910
Mailing Address - Fax:413-584-7270
Practice Address - Street 1:10 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-3160
Practice Address - Country:US
Practice Address - Phone:413-586-8910
Practice Address - Fax:413-584-7270
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55773207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3038220Medicaid
MA3038220Medicaid
MAJ07827Medicare ID - Type Unspecified