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NPI Code Detail

MEDICARE: DR. TIMOTHY J P COOPER MD

MEDICARE: DR. TIMOTHY J P 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
1207L00000XAnesthesiology Physician112414MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558358838
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIMOTHY J P COOPER MD
Provider Business Mailing Address
First Line : 100 PERUQUE ESTATES LN
Second Line :
City : WENTZVILLE
State : MO
Zip : 63385-4923
Country : US
Telephone Number : 636-916-9094
Fax Number :
Provider Business Practice Location Address
First Line : 10 HOSPITAL DR
Second Line :
City : SAINT PETERS
State : MO
Zip : 63376-1659
Country : US
Telephone Number : 636-916-9094
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2005
Last Update Date : 09/05/2019

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