MEDICARE: DR. IRWIN 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	207L00000X	Anesthesiology Physician	G16641	CA

General Provider Information

NPI Number	:	1578704029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRWIN COOPER M.D.

Provider Business Mailing Address
First Line	:	2000 THE STRAND
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-2821
Country	:	US
Telephone Number	:	310-372-3560
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 THE STRAND
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-2821
Country	:	US
Telephone Number	:	310-372-3560
Fax Number	:

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

Provider Enumeration Date	:	03/12/2009
Last Update Date	:	03/12/2009

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