Provider Demographics
NPI:1780796185
Name:COOPER, STEPHAN M (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHAN
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 1:300 W HUTCHINGS ST
Mailing Address - Street 2:
Mailing Address - City:WINTERSET
Mailing Address - State:IA
Mailing Address - Zip Code:50273-2104
Mailing Address - Country:US
Mailing Address - Phone:515-462-2373
Mailing Address - Fax:515-462-5114
Practice Address - Street 1:300 W HUTCHINGS ST
Practice Address - Street 2:
Practice Address - City:WINTERSET
Practice Address - State:IA
Practice Address - Zip Code:50273-2104
Practice Address - Country:US
Practice Address - Phone:515-462-2373
Practice Address - Fax:515-462-5114
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA205822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1303701Medicaid
IA32076OtherBCBS
IA32076OtherBCBS
IA1303701Medicaid