Healthcare Provider Details

I. General information

NPI: 1851416317
Provider Name (Legal Business Name): MICHAEL JEFFREY COOPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SERENO DR
VALLEJO CA
94589-2441
US

IV. Provider business mailing address

978 CONDIT RD
LAFAYETTE CA
94549-4100
US

V. Phone/Fax

Practice location:
  • Phone: 707-651-1000
  • Fax: 707-651-3377
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberA34019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: