Provider Demographics
NPI:1174966931
Name:COOLEY, DARRIUS ANTHRAWE (IDC)
Entity type:Individual
Prefix:
First Name:DARRIUS
Middle Name:ANTHRAWE
Last Name:COOLEY
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5613 BENNION CT
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-3224
Mailing Address - Country:US
Mailing Address - Phone:619-948-6989
Mailing Address - Fax:
Practice Address - Street 1:5613 BENNION CT
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-3224
Practice Address - Country:US
Practice Address - Phone:619-948-6989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman