Healthcare Provider Details

I. General information

NPI: 1811952716
Provider Name (Legal Business Name): MATTHEW MARC COOPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151 S YALE AVE SUITE 1301
TULSA OK
74136-1907
US

IV. Provider business mailing address

6600 S YALE AVE SUITE 1400
TULSA OK
74136-3310
US

V. Phone/Fax

Practice location:
  • Phone: 918-502-3200
  • Fax: 918-502-3205
Mailing address:
  • Phone: 918-488-6001
  • Fax: 918-488-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number7037
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: