MEDICARE: DR. JIMMY L 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	207P00000X	Emergency Medicine Physician	M5673	TX

General Provider Information

NPI Number	:	1508873886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIMMY L COOPER MD

Provider Business Mailing Address
First Line	:	18731 CORSINI DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-1629
Country	:	US
Telephone Number	:	210-218-4852
Fax Number	:

Provider Business Practice Location Address
First Line	:	18007 IH 10 W
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-9536
Country	:	US
Telephone Number	:	210-530-1040
Fax Number	:	210-530-1187

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	05/29/2024

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