Provider Demographics
NPI:1720068919
Name:COOPER, DAVID ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROBERT
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 S AKERS ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-8309
Mailing Address - Country:US
Mailing Address - Phone:559-624-3710
Mailing Address - Fax:559-635-4001
Practice Address - Street 1:840 S AKERS ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-8309
Practice Address - Country:US
Practice Address - Phone:559-624-3710
Practice Address - Fax:559-635-4001
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56124208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G561240Medicaid
CA00G561240Medicare PIN
CAE36763Medicare UPIN