MR. Detrick Mark Cooter

NPI #1295560688 in Phoenix, Arizona

Provider Information

NPI Number: 1295560688
Entity Type: Individual
Name: MR. Detrick Mark Cooter
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Specialist
Enumeration Date: Sep 4, 2024
Last Updated: Sep 4, 2024

Practice Location

Address: 406 E MCLELLAN BLVD
City: Phoenix
State: Arizona
ZIP Code: 85012-1038
Phone: (505) 620-3864

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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