Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Detrick Mark Cooter

Individual provider Specialist · NPI 1295560688

Mr. Detrick Mark Cooter is a Specialist in Phoenix, Arizona. Practices as a sole proprietor. Licensed in District of Columbia.

Licensed in
DC
In the registry since
2024
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Practice location Address checks out

406 E McLellan Blvd
Phoenix, AZ 85012-1038
Phone: (505) 620-3864
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence CSP40000064 (DC)

Record details

NPI number1295560688
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedSeptember 4, 2024
Last updated in NPPESSeptember 4, 2024
Certification dateSeptember 4, 2024

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