Individual
DR. JERRY D COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
2565 CHANNING WAY, IDAHO FALLS, ID 83404-7516
(208) 523-2928
(208) 523-2962
Mailing address
2565 CHANNING WAY, IDAHO FALLS, ID 83404-7516
(208) 523-2928
(208) 523-2962
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
P126
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001393600
—
ID
Enumeration date
10/19/2005
Last updated
06/11/2013
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