MEDICARE: DIANNE MARGARET 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	207RR0500X	Rheumatology Physician	L6840	TX

General Provider Information

NPI Number	:	1649232810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANNE MARGARET COOPER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 9126
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-9126
Country	:	US
Telephone Number	:	940-692-1200
Fax Number	:	940-692-1205

Provider Business Practice Location Address
First Line	:	4412 KELL BLVD
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76309-4719
Country	:	US
Telephone Number	:	940-692-1200
Fax Number	:

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	11/28/2022

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