MEDICARE: ANDREW D. COOPER M.D.

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	5898557-1205	UT

General Provider Information

NPI Number	:	1477547164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW D. COOPER M.D.

Provider Business Mailing Address
First Line	:	1874 REDONDO AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-3118
Country	:	US
Telephone Number	:	801-487-2873
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 S 1100 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1500
Country	:	US
Telephone Number	:	801-533-2002
Fax Number	:	801-323-9546

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	07/08/2007

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