Provider Demographics
NPI:1790745420
Name:COOPER, THERESA ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:ANN
Last Name:COOPER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10131 S YALE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-6002
Mailing Address - Country:US
Mailing Address - Phone:918-369-6274
Mailing Address - Fax:918-369-6278
Practice Address - Street 1:10131 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-6002
Practice Address - Country:US
Practice Address - Phone:918-369-6274
Practice Address - Fax:918-369-6278
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG37041Medicare UPIN