Provider Demographics
NPI:1497752489
Name:COOPER, MARK ELBERT (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ELBERT
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:410 42ND AVE N STE 400
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-3658
Mailing Address - Country:US
Mailing Address - Phone:615-292-5722
Mailing Address - Fax:615-346-6225
Practice Address - Street 1:410 42ND AVE N STE 400
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-3658
Practice Address - Country:US
Practice Address - Phone:615-329-7887
Practice Address - Fax:615-346-6225
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD25425208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3093746Medicare PIN
TN3093745Medicare PIN
TNF76137Medicare UPIN