Provider Demographics
NPI:1578531372
Name:COOPER, RICHARD MARK (DPM, INC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MARK
Last Name:COOPER
Suffix:
Gender:M
Credentials:DPM, INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7325 MEDICAL CENTER DR
Mailing Address - Street 2:#304
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1925
Mailing Address - Country:US
Mailing Address - Phone:818-999-3200
Mailing Address - Fax:818-884-4263
Practice Address - Street 1:7325 MEDICAL CENTER DR
Practice Address - Street 2:#304
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1925
Practice Address - Country:US
Practice Address - Phone:818-999-3200
Practice Address - Fax:818-884-4263
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2879213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE2879OtherSTATE LICENSE
CAE2879OtherSTATE LICENSE
CAWE2879AMedicare PIN