Individual
LARRY J COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1001 W EAGLE DR, DECATUR, TX 76234-3745
(940) 627-7443
(940) 627-7597
Mailing address
1001 W EAGLE DR, DECATUR, TX 76234-3745
(940) 627-7443
(940) 627-7597
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
D2400
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136183401
—
TX
05
—
160034488
—
TX
01
—
300067917
RAILROAD MEDICARE
TX
Enumeration date
05/26/2005
Last updated
11/30/2007
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