Provider Demographics
NPI:1639239205
Name:COOPER, JEFFREY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23372 COMPASS CT
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4437
Mailing Address - Country:US
Mailing Address - Phone:510-885-9818
Mailing Address - Fax:510-885-9818
Practice Address - Street 1:39120 ARGONAUT WAY # 275
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1304
Practice Address - Country:US
Practice Address - Phone:510-796-0770
Practice Address - Fax:510-796-7099
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0PA149660363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24638ZMedicare PIN
CAOPA149661Medicare PIN