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General NPI Number Information
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NPI Number | 1902230402
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Entity Type | Individual
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Provider Name | JEFFREY D. COOPER AU.D.
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Gender | Male
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Dates
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Enumeration Date | 09/03/2013
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Last Update Date | 09/03/2013
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Provider Practice Location Address
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Address Line | 76C COUNTY ROAD 6500
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City | KIRTLAND
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State | NM
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Zip | 87417-9402
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Country | US
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Telephone | 505-215-1998
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Fax | 505-598-5894
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Provider Business Mailing Address
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Address Line | 76C COUNTY ROAD 6500
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City | KIRTLAND
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State | NM
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Zip | 87417-9402
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Country | US
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Telephone | 505-215-1998
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Fax | 505-598-5894
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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 | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 5397
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License Number State | NM
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