Provider Demographics
NPI:1528154689
Name:COOPER, STEPHEN HART (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:HART
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 1:18399 VENTURA BLVD
Mailing Address - Street 2:#248
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356
Mailing Address - Country:US
Mailing Address - Phone:818-708-3600
Mailing Address - Fax:818-708-1648
Practice Address - Street 1:18399 VENTURA BLVD
Practice Address - Street 2:#248
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356
Practice Address - Country:US
Practice Address - Phone:818-708-3600
Practice Address - Fax:818-708-1648
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23523207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23523Medicaid
CAA23523Medicaid
A23523Medicare ID - Type Unspecified