MEDICARE: DR. JOSEPH 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	207P00000X	Emergency Medicine Physician	118195	MO

Other Identifiers

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

General Provider Information

NPI Number	:	1679560080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH COOPER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 4046
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65808-4046
Country	:	US
Telephone Number	:	417-269-5712
Fax Number	:	417-269-7567

Provider Business Practice Location Address
First Line	:	1423 N JEFFERSON AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65802-1917
Country	:	US
Telephone Number	:	417-269-6583
Fax Number	:	417-269-6573

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	08/19/2019

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