Healthcare Provider Details

I. General information

NPI: 1154322709
Provider Name (Legal Business Name): WILLIAM H COOPER IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date: 03/22/2006
Reactivation Date: 04/07/2006

III. Provider practice location address

1500 MEDICAL CENTER DR
WILMINGTON NC
28401-7507
US

IV. Provider business mailing address

1500 MEDICAL CENTER DR
WILMINGTON NC
28401-7507
US

V. Phone/Fax

Practice location:
  • Phone: 910-763-9509
  • Fax: 910-763-1058
Mailing address:
  • Phone: 910-763-9509
  • Fax: 910-763-1058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number28957
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: