Individual provider · NPI-1

Dr. Mark J. Cooper, M.D.

Family Medicine · Crestview, FL

NPI number1063481182
StatusActive
Last updated in NPPESJun 24, 2010

Details

NPI
1063481182
Entity type
Individual (NPI-1)
Name
Dr. Mark J. Cooper
Credential
M.D.
Sex
Male
Sole proprietor
No
Enumeration date
Mar 14, 2006
Last updated
Jun 24, 2010

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family MedicineME90602FLYes

Practice location

550 Redstone Ave W
Suite 200
Crestview, FL 32536-6430

Phone 850-682-6122 · Fax 850-682-5917

Mailing address

Po Box 2699
Pensacola, FL 32513-2699

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