Provider Demographics
NPI:1578096004
Name:COOPER, GUY PAUL JR (DO)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:PAUL
Last Name:COOPER
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:SCHNECK MEDICAL CENTER
Mailing Address - Street 2:411 W TIPTON ST
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-3082
Mailing Address - Country:US
Mailing Address - Phone:812-522-4253
Mailing Address - Fax:812-524-4255
Practice Address - Street 1:411 W TIPTON ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2363
Practice Address - Country:US
Practice Address - Phone:812-524-4253
Practice Address - Fax:812-524-4255
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02006289A208100000X
MS390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation