Healthcare Provider Details

I. General information

NPI: 1912982851
Provider Name (Legal Business Name): EDWARD CECIL COOPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3161 WALNUT AVE
FREMONT CA
94538-2216
US

IV. Provider business mailing address

PO BOX 1129
DANVILLE CA
94526-8129
US

V. Phone/Fax

Practice location:
  • Phone: 510-796-1000
  • Fax: 510-796-1050
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG32478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: