Provider Demographics
NPI:1669478806
Name:COOMER, THERESA ANN (MD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:COOMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:ANN
Other - Last Name:MCGUINNESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5995B HIGHWAY 72 E
Mailing Address - Street 2:
Mailing Address - City:GURLEY
Mailing Address - State:AL
Mailing Address - Zip Code:35748-9460
Mailing Address - Country:US
Mailing Address - Phone:256-776-2094
Mailing Address - Fax:256-776-0047
Practice Address - Street 1:5995B HIGHWAY 72 E
Practice Address - Street 2:
Practice Address - City:GURLEY
Practice Address - State:AL
Practice Address - Zip Code:35748-9460
Practice Address - Country:US
Practice Address - Phone:256-776-2094
Practice Address - Fax:256-776-0047
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00020563207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL543415010Medicaid
AL51526443Medicare PIN
G45649Medicare UPIN