Provider Demographics
NPI:1730479833
Name:COOPER, SIOBHAN KATHERINE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:SIOBHAN
Middle Name:KATHERINE
Last Name:COOPER
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:61188 LODGEPOLE DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2880
Mailing Address - Country:US
Mailing Address - Phone:541-891-5132
Mailing Address - Fax:
Practice Address - Street 1:384 SE COMBS FLAT RD
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-2562
Practice Address - Country:US
Practice Address - Phone:541-447-8750
Practice Address - Fax:541-447-8428
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD166362207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine