Individual
DR. SHELBY O. COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
207 N TOWNLINE RD STE 204, LAGRANGE, IN 46761-1325
(260) 463-9470
(260) 665-7312
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01021456A
IN
207VG0400X
Gynecology Physician
01021456
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100408010
—
IN
Enumeration date
10/11/2006
Last updated
10/10/2022
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