Provider Demographics
NPI:1558401513
Name:COOPER, DANIEL F JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:F
Last Name:COOPER
Suffix:JR
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 1:5310 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-9447
Mailing Address - Country:US
Mailing Address - Phone:317-873-2371
Mailing Address - Fax:317-873-2371
Practice Address - Street 1:5310 WILLOW RD
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-9447
Practice Address - Country:US
Practice Address - Phone:317-873-2371
Practice Address - Fax:317-873-2371
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01020768174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INAC2643319OtherDEA#
INAC2643319OtherDEA#