Individual
BRUCE COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
22 W MAIN ST, NIANTIC, CT 06357-2340
(860) 739-4431
(860) 739-9461
Mailing address
22 W MAIN ST, NIANTIC, CT 06357-2340
(860) 739-4431
(860) 739-9461
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
24339
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010024339CT01
BS/BC
CT
01
—
030023
HEALTHNET
CT
05
—
1243393
—
CT
Enumeration date
08/25/2005
Last updated
12/01/2008
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