MEDICARE: DR. JOHN ALLEN COOPER MD, PHD

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	208D00000X	General Practice Physician	2013042707	MO

General Provider Information

NPI Number	:	1518398916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ALLEN COOPER MD, PHD

Provider Business Mailing Address
First Line	:	40 N KINGSHIGHWAY BLVD APT 13F
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1343
Country	:	US
Telephone Number	:	314-669-5551
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 N KINGSHIGHWAY BLVD APT 13F
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1343
Country	:	US
Telephone Number	:	314-669-5551
Fax Number	:

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

Provider Enumeration Date	:	12/10/2013
Last Update Date	:	12/10/2013

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