Healthcare Provider Details

I. General information

NPI: 1629039946
Provider Name (Legal Business Name): EDGAR S. COOPER M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5339 ODONAVAN
BATON ROUGE LA
70808-4388
US

IV. Provider business mailing address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 225-766-4999
  • Fax: 225-763-5870
Mailing address:
  • Phone: 504-842-3387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License NumberMD 010933
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD.010933
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: