Provider Demographics
NPI:1508873886
Name:COOPER, JIMMY L (MD)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:L
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:18731 CORSINI DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-1629
Mailing Address - Country:US
Mailing Address - Phone:210-218-4852
Mailing Address - Fax:
Practice Address - Street 1:18007 IH 10 W
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-9536
Practice Address - Country:US
Practice Address - Phone:210-530-1040
Practice Address - Fax:210-530-1187
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5673207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine