MEDICARE: DEBRA COOPER DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	34006196C	OH
2	207Q00000X	Family Medicine Physician	20A10878	CA
3	207Q00000X	Family Medicine Physician	2017-00569	NC
4	207Q00000X	Family Medicine Physician	4361	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144261249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA COOPER DO

Provider Business Mailing Address
First Line	:	52 12TH AVE NE
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28601-2798
Country	:	US
Telephone Number	:	828-328-2941
Fax Number	:	828-328-4049

Provider Business Practice Location Address
First Line	:	52 12TH AVE NE
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28601-2798
Country	:	US
Telephone Number	:	828-328-2941
Fax Number	:	828-328-4049

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	10/18/2018

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Directions to “ DEBRA COOPER DO” Practice Location

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