Provider Demographics
NPI:1255345294
Name:COOPER, DONALD L (DO)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:L
Last Name:COOPER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:700 W 7TH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BRISTOW
Mailing Address - State:OK
Mailing Address - Zip Code:74010-2302
Mailing Address - Country:US
Mailing Address - Phone:918-367-5531
Mailing Address - Fax:918-367-1747
Practice Address - Street 1:700 W 7TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BRISTOW
Practice Address - State:OK
Practice Address - Zip Code:74010-2302
Practice Address - Country:US
Practice Address - Phone:918-367-5531
Practice Address - Fax:918-367-1747
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-05-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK1938207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100100320CMedicaid
OK249424705Medicare PIN
D38527Medicare UPIN