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General NPI Number Information
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NPI Number | 1447696331
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Entity Type | Organization
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Legal Business Name | LESLIE W COOPER MD PLLC
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Dates
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Enumeration Date | 05/17/2013
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Last Update Date | 05/17/2013
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Provider Practice Location Address
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Address Line | 8931 SACKETT DR
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City | PARK CITY
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State | UT
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Zip | 84098-5836
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Country | US
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Telephone | 866-654-7013
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Fax |
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Provider Business Mailing Address
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Address Line | 8931 SACKETT DR
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City | PARK CITY
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State | UT
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Zip | 84098-5836
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER / DOCTOR
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Name | DR. LESLIE WERDER COOPER
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Credential | M.D.
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Telephone | 866-654-7013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 5614879-1205
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License Number State | UT
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