Individual
DR. JACK MEDFORD COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
634 UPTOWN BLVD, CEDAR HILL, TX 75104-3529
(972) 637-1300
(866) 353-7586
Mailing address
634 UPTOWN BLVD, CEDAR HILL, TX 75104-3529
(972) 637-1300
(866) 353-7586
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
F2614
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0016DQ
BCBS GROUP
TX
01
—
0612336
AETNA HMO
—
05
—
112288904
—
TX
05
—
112288905
—
TX
01
—
180011221
MEDICARE RR DALLAS COUNTY
TX
01
—
180032049
MEDICARE RR ELLIS COUNTY
TX
01
—
2314758
BCBS BLUE LINK
TX
01
—
4237247
AETNA PPO
—
01
—
751622524
UNITED HEALTHCARE
—
01
—
86770X
BCBS PROVIDER ID
TX
Enumeration date
10/04/2006
Last updated
12/29/2011
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