Individual
DR. BLAKE A COOPER
Active
Individual
DR. BLAKE A COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
2001014975
MO
207W00000X
Ophthalmology Physician
Primary
0430052
KS
207W00000X
Ophthalmology Physician
2001014975
MO
207WX0107X
Retina Specialist (Ophthalmology) Physician
0430052
KS
207WX0107X
Retina Specialist (Ophthalmology) Physician
2001014975
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102970
BLUE CROSS BLUE SHIELD OF
KS
05
—
205348923
—
MO
01
—
32456016
BLUE CROSS BLUE SHIELD OF
MO
01
—
P00024558
RAILROAD MEDICARE
MO
01
—
P00303366
RAILROAD MEDICARE
KS
Enumeration date
06/22/2006
Last updated
08/26/2022
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