Healthcare Provider Details

I. General information

NPI: 1548297013
Provider Name (Legal Business Name): EMMETT GEORGE COOPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 WILLIAM HOWARD TAFT RD
CINCINNATI OH
45219-2103
US

IV. Provider business mailing address

125 WILLIAM HOWARD TAFT RD
CINCINNATI OH
45219-2103
US

V. Phone/Fax

Practice location:
  • Phone: 513-616-8774
  • Fax:
Mailing address:
  • Phone: 513-861-9433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number35-039200
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35-039200
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: