Provider Demographics
NPI:1932352432
Name:COOPER, BOBBI SUE (PA-C)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:SUE
Last Name:COOPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 E ARAPAHOE RD
Mailing Address - Street 2:SUITE B110
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4028
Mailing Address - Country:US
Mailing Address - Phone:720-870-7446
Mailing Address - Fax:720-870-7460
Practice Address - Street 1:14100 E ARAPAHOE RD
Practice Address - Street 2:SUITE B110
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4028
Practice Address - Country:US
Practice Address - Phone:720-870-7446
Practice Address - Fax:720-870-7460
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA2704363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOAAA1325Medicare PIN