Provider Demographics
NPI:1477618403
Name:COOPER, WILLIAM L (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:416 FRONTAGE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7770
Mailing Address - Country:US
Mailing Address - Phone:907-335-2100
Mailing Address - Fax:907-335-2160
Practice Address - Street 1:416 FRONTAGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7770
Practice Address - Country:US
Practice Address - Phone:907-335-2100
Practice Address - Fax:907-335-2160
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AKMD 2004208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2004Medicaid
AKBC7103257OtherDEA
AKMD2004Medicaid