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Individual
TRICIA L COOPERRIDER
Active
Individual
TRICIA L COOPERRIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4166
IA
208000000X
Pediatrics Physician
R8398
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528220563
—
IA
Enumeration date
07/01/2008
Last updated
05/22/2012
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