Provider Demographics
NPI:1518057108
Name:COOPER, H DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:H
Middle Name:DOUGLAS
Last Name:COOPER
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 1:1220 25TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5005
Mailing Address - Country:US
Mailing Address - Phone:916-452-4706
Mailing Address - Fax:916-452-4708
Practice Address - Street 1:1220 25TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5005
Practice Address - Country:US
Practice Address - Phone:916-452-4706
Practice Address - Fax:916-452-4708
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA45704207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB64484Medicare UPIN