Individual
CARRIE L. COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1301 W 38TH ST #205, AUSTIN, TX 78705-1011
(512) 324-1864
(512) 419-9016
Mailing address
PO BOX 26726, AUSTIN, TX 78755-0726
(512) 407-8686
(512) 421-4489
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
J1076
TX
207R00000X
Internal Medicine Physician
Primary
J1076
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
034366703
—
TX
05
—
034366704
—
TX
Enumeration date
08/24/2006
Last updated
12/15/2010
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