| NPI | 1013209956 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROY EDWARD COOPER Owner 870-972-8521 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AR C8114) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AR PA- 439) |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2011-05-11 |