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NPI Code Detail

MEDICARE: DANIEL J COOPER DO

MEDICARE: DANIEL J COOPER DO
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
1207Q00000XFamily Medicine Physician20A6218CA

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 : 1790770022
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL J COOPER DO
Provider Business Mailing Address
First Line : 600 COFFEE RD
Second Line :
City : MODESTO
State : CA
Zip : 95355-4201
Country : US
Telephone Number : 209-521-6097
Fax Number :
Provider Business Practice Location Address
First Line : 2505 W HAMMER LN
Second Line :
City : STOCKTON
State : CA
Zip : 95209-2839
Country : US
Telephone Number : 209-957-7050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2005
Last Update Date : 03/17/2018

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