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1568551414 NPI number — SHELBY O. COOPER M.D.

NPI Number: 1568551414
Health Care Provider/Practitioner: SHELBY O. COOPER M.D.

Information about “1568551414” NPI (SHELBY O. COOPER M.D.) exists in 1568551414 in HTML format HTML  |  1568551414 in plain Text format TXT  |  1568551414 in PDF (Portable Document Format) PDF  |  1568551414 in an XML format XML  formats.

NPI Number : 1568551414 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568551414",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COOPER",
    "FirstName": "SHELBY",
    "MiddleName": "O.",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "11109 PARKVIEW PLAZA DR # 117",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FORT WAYNE",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "46845-1701",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "207 N TOWNLINE RD STE 204",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAGRANGE",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46761-1325",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "260-463-9470",
    "PracticeLocationAddressFaxNumber": "260-665-7312",
    "EnumerationDate": "10/11/2006",
    "LastUpdateDate": "10/10/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207VG0400X",
          "TaxonomyName": "Gynecology Physician",
          "LicenseNumber": "01021456",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207V00000X",
          "TaxonomyName": "Obstetrics & Gynecology Physician",
          "LicenseNumber": "01021456A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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