Healthcare Provider Details

I. General information

NPI: 1528858107
Provider Name (Legal Business Name): COOPER JAROD RUWE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 23RD AVE S
NASHVILLE TN
37212-3133
US

IV. Provider business mailing address

833 W DAKIN ST APT 3
CHICAGO IL
60613-6535
US

V. Phone/Fax

Practice location:
  • Phone: 615-421-4201
  • Fax:
Mailing address:
  • Phone: 601-572-7771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: