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General NPI Number Information
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NPI Number | 1194729525
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Entity Type | Individual
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Provider Name | ROBERT WAYNE COOPER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 475 N HIGHWAY 25 W # WN SUITE 100
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City | WILLIAMSBURG
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State | KY
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Zip | 40769-1576
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Country | US
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Telephone | 606-549-2933
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Fax | 606-549-3036
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Provider Business Mailing Address
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Address Line | PO BOX 247
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City | JELLICO
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State | TN
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Zip | 37762-0247
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Country | US
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Telephone | 606-549-2933
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Fax | 606-549-3036
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 18598
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License Number State | KY
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