Provider Demographics
NPI:1447548391
Name:ORR, BRENT COOPER (ATP)
Entity type:Individual
Prefix:MR
First Name:BRENT
Middle Name:COOPER
Last Name:ORR
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7415 WHITEHALL STREET SUITE 118
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76118
Mailing Address - Country:US
Mailing Address - Phone:817-589-0759
Mailing Address - Fax:817-284-1798
Practice Address - Street 1:7415 WHITEHALL STREET SUITE 118
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76118
Practice Address - Country:US
Practice Address - Phone:817-589-0759
Practice Address - Fax:817-284-1798
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other