Provider Demographics
NPI:1023267630
Name:COOPER, KEVIN SCOTT (MD,MPH)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:SCOTT
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 DENNY AVE
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5509
Mailing Address - Country:US
Mailing Address - Phone:228-762-2044
Mailing Address - Fax:228-762-2064
Practice Address - Street 1:4305 DENNY AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5509
Practice Address - Country:US
Practice Address - Phone:228-762-2044
Practice Address - Fax:228-762-2064
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13038207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS010000331Medicare PIN