Individual
RUSSELL WILLIAM COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CTRS
Contact information
Practice address
8495 CRATER LAKE HWY, WHITE CITY, OR 97503-3011
(541) 826-2111
Mailing address
2522 BEL ABBES AVE, MEDFORD, OR 97504-1737
(541) 779-1171
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
07/10/2006
Last updated
07/08/2007
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