Provider Demographics
NPI:1912272568
Name:COOPER, MICHAEL SCOT (IDMT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SCOT
Last Name:COOPER
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
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Mailing Address - Street 1:6973 ZUCKERT AVENUE
Mailing Address - Street 2:176TH MEDICAL GROUP
Mailing Address - City:JBER
Mailing Address - State:AK
Mailing Address - Zip Code:99506
Mailing Address - Country:US
Mailing Address - Phone:907-551-0435
Mailing Address - Fax:907-551-0431
Practice Address - Street 1:6973 ZUCKERT AVENUE
Practice Address - Street 2:176TH MEDICAL GROUP
Practice Address - City:ELMENDORF/ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99506
Practice Address - Country:US
Practice Address - Phone:907-551-0435
Practice Address - Fax:907-551-0431
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK627146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic