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NPI Code Detail

MEDICARE: MARK A COOPER M.D.

MEDICARE: MARK A 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
1207R00000XInternal Medicine Physician29115TN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
438241821OTHERTNMEDICARE PTAN
53380640OTHERTNMEDICARE GROUP

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
229115OTHERTNMD LLICENSE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881681666
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK A COOPER M.D.
Provider Business Mailing Address
First Line : 205 HOSPITAL DRIVE
Second Line : SUITE A
City : MCKENZIE
State : TN
Zip : 38201
Country : US
Telephone Number : 731-352-7907
Fax Number : 731-352-4459
Provider Business Practice Location Address
First Line : 136 S WILSON ST
Second Line :
City : DRESDEN
State : TN
Zip : 38225-1133
Country : US
Telephone Number : 731-364-4900
Fax Number : 731-352-4459
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2005
Last Update Date : 03/07/2023

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Directions to “ MARK A COOPER M.D.” Practice Location

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