Individual
MR. DETRICK MARK COOTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
406 E MCLELLAN BLVD, PHOENIX, AZ 85012-1038
(505) 620-3864
Mailing address
406 E MCLELLAN BLVD, PHOENIX, AZ 85012-1038
(505) 620-3864
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
CSP40000064
DC
Other
Enumeration date
09/04/2024
Last updated
09/04/2024
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