Individual
COOPER L RENDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7635 ADDISEN PATH, INVER GROVE HEIGHTS, MN 55077-4108
(805) 698-8480
Mailing address
7635 ADDISEN PATH, INVER GROVE HEIGHTS, MN 55077-4108
(805) 698-8480
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
11671
MN
363A00000X
Physician Assistant
085-004146
IL
363AM0700X
Medical Physician Assistant
11671
MN
Other
Enumeration date
09/26/2011
Last updated
05/02/2018
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