Provider Demographics
NPI:1538217781
Name:COOPER, ROBERT JOE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOE
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 N CAMDEN DR
Mailing Address - Street 2:# 1140
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4409
Mailing Address - Country:US
Mailing Address - Phone:310-273-2360
Mailing Address - Fax:310-273-0580
Practice Address - Street 1:433 N CAMDEN DR
Practice Address - Street 2:# 1140
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4409
Practice Address - Country:US
Practice Address - Phone:310-273-2360
Practice Address - Fax:310-273-0580
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24706174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist