Provider Demographics
NPI:1356913503
Name:COOPER, BRUCE
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 RANCHO BERNARDO TRL
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-8524
Mailing Address - Country:US
Mailing Address - Phone:972-670-9409
Mailing Address - Fax:
Practice Address - Street 1:4901 RANCHO BERNARDO TRL
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-8524
Practice Address - Country:US
Practice Address - Phone:972-670-9409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date: