Individual
MR. JACK MARSHALL COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
470 TAYLOR RD, SUITE 202, MONTGOMERY, AL 36117-3563
(334) 244-6773
(334) 244-4234
Mailing address
301 BROWN SPRINGS RD, MONTGOMERY, AL 36117-7005
(334) 747-4159
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2012-00248
NC
208600000X
Surgery Physician
Primary
32228
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149171
—
AL
05
—
5920296
—
NC
Enumeration date
11/05/2007
Last updated
01/05/2023
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