Individual
JEFFREY C COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
211 N EDDY ST, SOUTH BEND, IN 46617-2808
(574) 243-4450
(574) 243-4405
Mailing address
211 N EDDY ST, SOUTH BEND, IN 46617-2808
(574) 243-4450
(574) 243-4405
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
01043721A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000110542
ANTHEM PROVIDER NUMBER
IN
05
—
200038580
—
IN
Enumeration date
03/14/2006
Last updated
11/12/2014
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