Individual
GARY SCOTT COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
283 MADONNA RD, SUITE B, SAN LUIS OBISPO, CA 93405-5432
(805) 549-8880
(805) 549-8743
Mailing address
283 MADONNA RD, SUITE B, SAN LUIS OBISPO, CA 93405-5432
(805) 549-8880
(805) 549-8743
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA15219
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA15219
PA LICENSE
CA
Enumeration date
03/16/2007
Last updated
07/10/2007
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