Individual
COOPER CAMPBELL WRISTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 COLCHESTER AVE, BURLINGTON, VT 05401-1473
(802) 847-0000
Mailing address
111 COLCHESTER AVE, BURLINGTON, VT 05401-1473
(802) 847-0000
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
042-0017489
VT
207N00000X
Dermatology Physician
105037
MN
207N00000X
Dermatology Physician
53518
MN
390200000X
Student in an Organized Health Care Education/Training Program
158106
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
MN
Enumeration date
06/22/2009
Last updated
01/17/2024
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