Individual
VIDETTE V COOPER
Active
Individual
VIDETTE V COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
22230
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5909335
—
NC
05
—
764356
—
SC
01
—
GP1883
MEDICAID GROUP
SC
01
—
GP4306
MEDICAID GROUP
SC
01
—
GP4840
MEDICAID GROUP
SC
05
—
T64356
—
SC
Enumeration date
05/03/2006
Last updated
03/11/2014
Update your record
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