Provider Demographics
NPI:1861492324
Name:COOPER, JOHN R JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:COOPER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4398
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4398
Mailing Address - Country:US
Mailing Address - Phone:832-355-2666
Mailing Address - Fax:832-355-6500
Practice Address - Street 1:6720 BERTNER ST
Practice Address - Street 2:SUITE O-520
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2604
Practice Address - Country:US
Practice Address - Phone:832-355-2666
Practice Address - Fax:832-355-6500
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2615207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119063902Medicaid
TX119063904Medicaid
TX119063904Medicaid
TXP00317179Medicare PIN
TX87C747Medicare PIN
TXD48152Medicare UPIN
TX8G3078Medicare PIN