Organization
COOPER CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT M NELSON JR. (ADMINISTRATOR)
(972) 560-2667
Entity
Organization
Contact information
Practice address
12200 PRESTON RD, DALLAS, TX 75230-2223
(972) 560-2667
(972) 239-6649
Mailing address
12200 PRESTON RD, DALLAS, TX 75230-2223
(972) 560-2667
(972) 239-6649
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00L286
BLUE CROSS BLUE SHIELD
TX
Enumeration date
07/25/2006
Last updated
08/22/2020
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