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NPI Code Detail

MEDICARE: LARRY J COOPER MD

MEDICARE:   LARRY J 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
12085R0202XDiagnostic Radiology PhysicianD2400TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2300067917OTHERTXRAILROAD MEDICARE

Other Identifiers

General Provider Information

NPI Number : 1831192574
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARRY J COOPER MD
Provider Business Mailing Address
First Line : 1001 W EAGLE DR
Second Line :
City : DECATUR
State : TX
Zip : 76234-3745
Country : US
Telephone Number : 940-627-7443
Fax Number : 940-627-7597
Provider Business Practice Location Address
First Line : 1001 W EAGLE DR
Second Line :
City : DECATUR
State : TX
Zip : 76234-3745
Country : US
Telephone Number : 940-627-7443
Fax Number : 940-627-7597
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2005
Last Update Date : 11/30/2007

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Directions to “ LARRY J COOPER MD” Practice Location

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