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Individual

COOPER LOOMIS TERRY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
497 AZALEA DR, SUITE 102, OXFORD, MS 38655-7905
(662) 513-2000
(662) 513-2001
Mailing address
497 AZALEA DR, SUITE 102, OXFORD, MS 38655-7905
(662) 513-2000
(662) 513-2001

Taxonomy

Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
14854
MS
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
14854
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00117049
MS
Enumeration date
07/05/2006
Last updated
04/10/2019
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