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Individual

DR. THOMAS W COOPER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
630 S FLEISHEL AVE, TYLER, TX 75701-2041
(903) 533-1491
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
D6992
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
010064699
MEDICARE RAILROAD
TX
01
123038
CHIPS
TX
05
141088801
TX
01
4380144
AETNA
TX
01
752616977009
TRICARE CHAMPUS
TX
01
752616977010
TRICARE
TX
01
752616977015
TRICARE
TX
01
CO088865G
BCBS
TX
Enumeration date
02/10/2006
Last updated
10/10/2014
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