Cooper, Jac Alan

Cooper, Jac Alan is an individual health care provider with primary practice located at 85 E Us Highway 6 Ste 240 , Valparaiso IN 46383. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgical Critical Care, which is considered as his primary health care specialty. Cooper, Jac Alan can be contacted via phone (219) 983-6240.

Contact Information

Primary practice address
85 E Us Highway 6 Ste 240 Valparaiso IN 46383
Phone: (219) 983-6240
Fax: (219) 983-6040
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgical Critical Care 2086S0102X 01035869A Indiana

Profile Details

NPI number 1760487425
LBN Legal business name Cooper, Jac Alan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 17th, 2005
Last updated Sep 14th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760487425 NPPES
Indiana MEDICAID 100207020
Indiana Other 000000082449

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