Provider Demographics
NPI:1134362478
Name:COOPER, CLAIRICE ANN (MD (AS OF 5/1/09))
Entity type:Individual
Prefix:MRS
First Name:CLAIRICE
Middle Name:ANN
Last Name:COOPER
Suffix:
Gender:F
Credentials:MD (AS OF 5/1/09)
Other - Prefix:
Other - First Name:CLAIRICE
Other - Middle Name:ANN
Other - Last Name:BAKKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:462 GRIDER ST
Mailing Address - Street 2:DEPT. OF SURGERY - MILLER BLDG.
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3021
Mailing Address - Country:US
Mailing Address - Phone:716-898-5186
Mailing Address - Fax:716-898-3194
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:DEPT. OF SURGERY - MILLER BLDG.
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-5186
Practice Address - Fax:716-898-3194
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275399208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery