Provider Demographics
NPI:1063941383
Name:COOPER, JOSEPH BENJAMIN (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BENJAMIN
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 N DIVISION AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-5054
Mailing Address - Country:US
Mailing Address - Phone:208-263-3091
Mailing Address - Fax:208-263-3147
Practice Address - Street 1:1218 N DIVISION AVE STE 208
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-5054
Practice Address - Country:US
Practice Address - Phone:208-263-3091
Practice Address - Fax:208-263-3147
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMC-2534207Q00000X, 207P00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist