Provider Demographics
NPI:1568492098
Name:COOPER, WILLIAM L (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
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 1:103 ALYCIA DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2368
Mailing Address - Country:US
Mailing Address - Phone:859-626-3412
Mailing Address - Fax:859-626-3663
Practice Address - Street 1:103 ALYCIA DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2368
Practice Address - Country:US
Practice Address - Phone:859-626-3412
Practice Address - Fax:859-626-3663
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY158452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000217321OtherANTHEM BLUE CROSS PIN
KYC64416OtherBLUEGRASS FAMILY HEALTH
KY64158454Medicaid
KY0698803Medicare PIN
KY000000217321OtherANTHEM BLUE CROSS PIN