MEDICARE: SAMANTHA 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	207Q00000X	Family Medicine Physician	R5377	TX

General Provider Information

NPI Number	:	1346699659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA COOPER DO

Provider Business Mailing Address
First Line	:	8440 WALNUT HILL LN STE 100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-3814
Country	:	US
Telephone Number	:	214-328-3566
Fax Number	:	214-328-0798

Provider Business Practice Location Address
First Line	:	8440 WALNUT HILL LN STE 100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-3814
Country	:	US
Telephone Number	:	214-328-3566
Fax Number	:	214-328-0798

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

Provider Enumeration Date	:	06/07/2016
Last Update Date	:	08/20/2019

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Directions to “ SAMANTHA COOPER DO” Practice Location

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