Individual
CLIVE R COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 N ROBBINS RD, BOISE, ID 83702-4565
(208) 385-3329
(208) 489-4063
Mailing address
1410 N 11TH ST, BOISE, ID 83702
(208) 367-1487
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M6445
ID
208M00000X
Hospitalist Physician
M6445
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003624900
—
ID
Enumeration date
06/16/2006
Last updated
08/10/2017
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