MEDICARE: STEPHAN K COOPER MD

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	207W00000X	Ophthalmology Physician	03318R	LA

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	1053315846	OTHER	LA	GROUP NPI NUMBER
3	180008739	OTHER	LA	RAILROAD MEDICIARE

General Provider Information

NPI Number	:	1407850316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHAN K COOPER MD

Provider Business Mailing Address
First Line	:	471 ASHLEY RIDGE BLVD.
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106
Country	:	US
Telephone Number	:	318-795-4770
Fax Number	:	318-795-4775

Provider Business Practice Location Address
First Line	:	471 ASHLEY RIDGE BLVD.
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106
Country	:	US
Telephone Number	:	318-795-4770
Fax Number	:	318-795-4775

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	01/12/2009

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