=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609169457
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CALVIN MICHAEL COOPER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2011
-----------------------------------------------------
Last Update Date | 01/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4101 JAMES CASEY ST STE 340
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78745-1145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-306-1323
-----------------------------------------------------
Fax | 512-306-1142
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 98 SAN JACINTO BLVD STE 1800
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78701-4237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-708-9700
-----------------------------------------------------
Fax | 512-410-2942
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | R6540
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------