Provider Demographics
NPI:1396522801
Name:COOPER, ROBERT EUGENE III (ATS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EUGENE
Last Name:COOPER
Suffix:III
Gender:M
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 GREENWOOD DR APT C
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-3388
Mailing Address - Country:US
Mailing Address - Phone:386-675-9946
Mailing Address - Fax:
Practice Address - Street 1:347 S GLADSTONE AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4892
Practice Address - Country:US
Practice Address - Phone:630-892-6431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program