Healthcare Provider Details

I. General information

NPI: 1912970799
Provider Name (Legal Business Name): KERRY COOPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 E WARNER RD SUITE 101
TEMPE AZ
85284-3493
US

IV. Provider business mailing address

2141 E WARNER RD SUITE 101
TEMPE AZ
85284-3493
US

V. Phone/Fax

Practice location:
  • Phone: 480-464-0189
  • Fax: 480-464-0189
Mailing address:
  • Phone: 480-464-0189
  • Fax: 480-464-0189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number28488
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: