Healthcare Provider Details

I. General information

NPI: 1013209956
Provider Name (Legal Business Name): R. EDWARD COOPER JR., M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E MATTHEWS AVE SUITE D
JONESBORO AR
72401-4307
US

IV. Provider business mailing address

1000 E MATTHEWS AVE SUITE D
JONESBORO AR
72401-4307
US

V. Phone/Fax

Practice location:
  • Phone: 870-972-8521
  • Fax: 870-972-8042
Mailing address:
  • Phone: 870-972-8521
  • Fax: 870-972-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberC8114
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA- 439
License Number StateAR

VIII. Authorized Official

Name: DR. ROY EDWARD COOPER JR.
Title or Position: OWNER
Credential: M.D.
Phone: 870-972-8521