Provider Demographics
NPI:1891760500
Name:COOLEY, REX DALE I (DO)
Entity Type:Individual
Prefix:
First Name:REX
Middle Name:DALE
Last Name:COOLEY
Suffix:I
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1871 W ORANGE GROVE RD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1289
Mailing Address - Country:US
Mailing Address - Phone:520-382-3050
Mailing Address - Fax:520-382-3055
Practice Address - Street 1:1871 W ORANGE GROVE RD
Practice Address - Street 2:SUITE 135
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1289
Practice Address - Country:US
Practice Address - Phone:520-382-3050
Practice Address - Fax:520-382-3055
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3733207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ687486Medicaid
AZ687486Medicaid
AZ118475Medicare PIN
AZZ69969Medicare PIN