Healthcare Provider Details

I. General information

NPI: 1184849259
Provider Name (Legal Business Name): MATTHEW COOPER MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7375 PEAK DR STE 110
LAS VEGAS NV
89128-9030
US

IV. Provider business mailing address

7375 PEAK DR STE 110
LAS VEGAS NV
89128-9030
US

V. Phone/Fax

Practice location:
  • Phone: 702-948-8080
  • Fax:
Mailing address:
  • Phone: 702-948-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW MARC COOPER
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 702-948-8080