Cooper, Tom
Cooper, Tom is an individual health care provider with primary practice located at 561 Medical Dr , Clarksdale MS 38614-6733. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Cooper, Tom can be contacted via phone (662) 627-5256.Contact Information
Primary practice address
561 Medical Dr
Clarksdale MS 38614-6733
Phone: (662) 627-5256
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | 05774 | Mississippi |
Profile Details
| NPI number | 1013013648 |
|---|---|
| LBN Legal business name | Cooper, Tom |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 14th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1013013648 | NPPES |
| Mississippi | MEDICAID | 00115320 |
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