Individual
CAROLYN COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1 WALTER SCHOLER DR, LAFAYETTE, IN 47909-6303
(765) 448-8000
(765) 448-8257
Mailing address
1400 WEST STATE STREET, BLDG B, STE C, WEST LAFAYETTE, IN 47906
(765) 494-0111
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01042922
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001100839
ANTHEM PROVIDER NUMBER
IN
05
—
100335050
—
IN
Enumeration date
11/01/2006
Last updated
07/21/2022
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