Healthcare Provider Details

I. General information

NPI: 1285706788
Provider Name (Legal Business Name): SUZANNE S COOPER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9094 E MINERAL AVE
CENTENNIAL CO
80112
US

IV. Provider business mailing address

9094 E MINERAL AVE
CENTENNIAL CO
80112
US

V. Phone/Fax

Practice location:
  • Phone: 303-694-3200
  • Fax: 303-694-2680
Mailing address:
  • Phone: 303-694-3200
  • Fax: 303-694-2680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number32474
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: