Provider Demographics
NPI:1538107172
Name:COOLEY, TONYA TRUONG (DO)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:TRUONG
Last Name:COOLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9780 WALNUT ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-2389
Mailing Address - Country:US
Mailing Address - Phone:972-889-8353
Mailing Address - Fax:972-889-8355
Practice Address - Street 1:9780 WALNUT ST
Practice Address - Street 2:SUITE 150
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-2389
Practice Address - Country:US
Practice Address - Phone:972-889-8353
Practice Address - Fax:972-889-8355
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0692207R00000X
MO100313207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F66995Medicare UPIN
0038ATMedicare ID - Type Unspecified