Healthcare Provider Details

I. General information

NPI: 1871632364
Provider Name (Legal Business Name): AMBER R COOPER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 N BALLAS RD STE 450 BLDG D
SAINT LOUIS MO
63131-2330
US

IV. Provider business mailing address

660 S EUCLID AVE C B 8064
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-2400
  • Fax: 314-286-2455
Mailing address:
  • Phone: 314-286-2400
  • Fax: 314-286-2455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number2007016078
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number2007016078
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: