Healthcare Provider Details

I. General information

NPI: 1538141155
Provider Name (Legal Business Name): DANIEL HUNT COOPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 03/07/2023
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 JACKSON ST SW
GRAVETTE AR
72736-9121
US

IV. Provider business mailing address

PO BOX 1251
SILOAM SPRINGS AR
72761-1251
US

V. Phone/Fax

Practice location:
  • Phone: 479-787-5291
  • Fax: 479-344-6404
Mailing address:
  • Phone: 918-422-4102
  • Fax: 918-422-4093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC8243
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: