Provider Demographics
NPI:1215490784
Name:COOPER, DAVID WAYNE (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:256 FORT SANDERS WEST BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3355
Mailing Address - Country:US
Mailing Address - Phone:865-934-3329
Mailing Address - Fax:865-769-4501
Practice Address - Street 1:260 FORT SANDERS WEST BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3355
Practice Address - Country:US
Practice Address - Phone:865-558-4400
Practice Address - Fax:865-558-4421
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01092439A207X00000X, 207XS0106X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01092439AOtherSTATE LICENSE
IN300086083Medicaid