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General NPI Number Information
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NPI Number | 1396799615
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Entity Type | Individual
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Provider Name | RONALD J COOPER MD
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Gender | Male
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 1111 DELAFIELD ST SUITE 219
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City | WAUKESHA
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State | WI
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Zip | 53188-3417
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Country | US
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Telephone | 262-951-8508
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Fax |
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Provider Business Mailing Address
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Address Line | 7060 RAINBOW LAKE RD
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City | LAKE TOMAHAWK
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State | WI
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Zip | 54539-9303
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Country | US
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Telephone | 715-892-6915
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Fax | 715-277-4577
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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 | 25226
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License Number State | WI
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