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General NPI Number Information
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NPI Number | 1487653663
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Entity Type | Individual
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Provider Name | GARY HARRY COOPER MD
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Gender | Male
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 2175 SOUTH AVE
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-7024
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Country | US
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Telephone | 530-543-5685
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Fax | 530-544-2503
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Provider Business Mailing Address
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Address Line | 1111 EMERALD BAY RD
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-6207
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Country | US
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Telephone | 530-543-5659
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Fax | 530-541-8723
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G19546
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | G19546
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License Number State | CA
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