Provider Demographics
NPI:1770576050
Name:COOPER, DOUGLAS M (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:M
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 1:201 E J AVENUE
Mailing Address - Street 2:
Mailing Address - City:GRUNDY CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50638
Mailing Address - Country:US
Mailing Address - Phone:319-824-5081
Mailing Address - Fax:319-824-5504
Practice Address - Street 1:201 E J AVENUE
Practice Address - Street 2:
Practice Address - City:GRUNDY CENTER
Practice Address - State:IA
Practice Address - Zip Code:50638
Practice Address - Country:US
Practice Address - Phone:319-824-5081
Practice Address - Fax:319-824-5504
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29245207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA13115OtherWELLMARK BCBS
IA0100859Medicaid
IA0100859Medicaid
IA13115OtherWELLMARK BCBS