Healthcare Provider Details

I. General information

NPI: 1861326142
Provider Name (Legal Business Name): BENJAMIN J COOPER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 UNION ST
BOONE IA
50036-4898
US

IV. Provider business mailing address

4707 CANTERBURY CT
IOWA CITY IA
52245-9205
US

V. Phone/Fax

Practice location:
  • Phone: 515-432-3140
  • Fax:
Mailing address:
  • Phone: 319-400-9129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: