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General NPI Number Information
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NPI Number | 1255511572
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Entity Type | Individual
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Provider Name | JACK MARSHALL COOPER MD
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Gender | Male
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 01/05/2023
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Provider Practice Location Address
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Address Line | 470 TAYLOR RD SUITE 202
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City | MONTGOMERY
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State | AL
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Zip | 36117-3563
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Country | US
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Telephone | 334-244-6773
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Fax | 334-244-4234
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Provider Business Mailing Address
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Address Line | 301 BROWN SPRINGS RD
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City | MONTGOMERY
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State | AL
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Zip | 36117-7005
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Country | US
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Telephone | 334-747-4159
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2012-00248
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 32228
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License Number State | AL
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