Individual
MARK A COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
136 S WILSON ST, DRESDEN, TN 38225-1133
(731) 364-4900
(731) 352-4459
Mailing address
205 HOSPITAL DRIVE, SUITE A, MCKENZIE, TN 38201
(731) 352-7907
(731) 352-4459
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
29115
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1509513
—
TN
01
—
29115
MD LLICENSE
TN
01
—
3380640
MEDICAID GROUP
TN
01
—
38241821
MEDICARE PTAN
TN
Enumeration date
10/05/2005
Last updated
03/07/2023
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