Healthcare Provider Details

I. General information

NPI: 1255345294
Provider Name (Legal Business Name): DONALD L. COOPER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W 7TH AVE SUITE 103
BRISTOW OK
74010-2302
US

IV. Provider business mailing address

700 W 7TH AVE SUITE 103
BRISTOW OK
74010-2302
US

V. Phone/Fax

Practice location:
  • Phone: 918-367-5531
  • Fax: 918-367-1747
Mailing address:
  • Phone: 918-367-5531
  • Fax: 918-367-1747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1938
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: