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Individual

DR. RICHARD GLYNN COOPER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2704 N OAK ST, BUILDING E, VALDOSTA, GA 31602-1744
(229) 333-9729
(229) 333-0832
Mailing address
PO BOX 3670, VALDOSTA, GA 31604-3670
(229) 244-8759

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
038209
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000597803A
GA
Enumeration date
11/07/2005
Last updated
01/12/2011
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