Provider Demographics
NPI:1851487458
Name:COOPER, DON E (CPED)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:E
Last Name:COOPER
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3857 SW LOOP 820
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-2076
Mailing Address - Country:US
Mailing Address - Phone:817-292-0305
Mailing Address - Fax:817-292-4070
Practice Address - Street 1:3857 SW LOOP 820
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-2076
Practice Address - Country:US
Practice Address - Phone:817-292-0305
Practice Address - Fax:817-292-4070
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1051020001Medicare ID - Type UnspecifiedPROVIDER #