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Individual

DR. RANDALL ALLEN COOPER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.P.M.

Contact information

Practice address
1723 E BRISTOL ST, ELKHART, IN 46514-3968
(574) 264-7180
(574) 264-1875
Mailing address
1723 E BRISTOL ST, ELKHART, IN 46514-3968
(574) 264-7180
(574) 264-1875

Taxonomy

Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
07000384A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100112180
IN
01
480010783
PALMETTO GBA-RAILROAD MEDICARE
IN
Enumeration date
01/03/2006
Last updated
01/27/2010
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