Healthcare Provider Details

I. General information

NPI: 1528134582
Provider Name (Legal Business Name): DAVID ALAN COOLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 BELLEFONTAINE AVE STE 100
LIMA OH
45804-1868
US

IV. Provider business mailing address

830 W HIGH ST SUITE 204
LIMA OH
45801-3971
US

V. Phone/Fax

Practice location:
  • Phone: 419-998-8234
  • Fax: 419-998-8233
Mailing address:
  • Phone: 419-229-8928
  • Fax: 419-229-5291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number35049465
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier341712408
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerOTHER INS
# 2
Identifier341712408
Identifier TypeOTHER
Identifier State
Identifier IssuerTRICARE
# 3
Identifier0859441
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer
# 4
IdentifierCL1312
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerMEDICARE RAILROAD
# 5
Identifier000000137184
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerANTHEM BLUE CROSS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: