Individual
DR. JACK MEDFORD COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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