Provider Demographics
NPI:1104111392
Name:COOPER, RICHARD BLAKE (ATP)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:BLAKE
Last Name:COOPER
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14045 RAWHIDE PKWY
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-3648
Mailing Address - Country:US
Mailing Address - Phone:972-623-7177
Mailing Address - Fax:877-602-1034
Practice Address - Street 1:2930 SKYWAY CIR N
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3509
Practice Address - Country:US
Practice Address - Phone:972-623-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other