Provider Demographics
NPI:1578702122
Name:COOPER, JOEL ROBIN (DO)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:ROBIN
Last Name:COOPER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JOEL
Other - Middle Name:R
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:8422 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE #103
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5633
Mailing Address - Country:US
Mailing Address - Phone:623-334-2818
Mailing Address - Fax:623-334-2814
Practice Address - Street 1:8422 W THUNDERBIRD RD
Practice Address - Street 2:SUITE #103
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5633
Practice Address - Country:US
Practice Address - Phone:623-334-2818
Practice Address - Fax:623-334-2814
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005360207Q00000X
KY03195207Q00000X
OH009702207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ624434Medicaid
AZ624434Medicaid