Individual
JAC ALAN COOPER SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
85 E US HIGHWAY 6 STE 240, VALPARAISO, IN 46383
(219) 983-6240
(219) 983-6040
Mailing address
2022 KELLE DR, CHESTERTON, IN 46304-8708
(219) 364-3616
(219) 364-3610
Taxonomy
Speciality
Code
Description
License number
State
2086S0102X
Surgical Critical Care Physician
Primary
01035869A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000082449
ANTHEM
IN
05
—
100207020
—
IN
Enumeration date
06/17/2005
Last updated
09/14/2020
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