Provider Demographics
NPI:1689316317
Name:COOPER, WILLIAM ELLIS
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ELLIS
Last Name:COOPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 UNIVERSITY BLVD.
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45324
Mailing Address - Country:US
Mailing Address - Phone:937-775-8188
Mailing Address - Fax:
Practice Address - Street 1:2555 UNIVERSITY BLVD.
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45324
Practice Address - Country:US
Practice Address - Phone:937-775-8188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program