Basic Information
| Provider Information | |||||||||
| NPI: | 1891747291 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOLEY | ||||||||
| FirstName: | VERNON | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 ROUND VALLEY DR | ||||||||
| Address2: | # 100 | ||||||||
| City: | PARK CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840607552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356556600 | ||||||||
| FaxNumber: | 4356552388 | ||||||||
| Practice Location | |||||||||
| Address1: | 1820 SIDEWINDER DR | ||||||||
| Address2: | |||||||||
| City: | PARK CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840607492 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356556600 | ||||||||
| FaxNumber: | 4356552388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 10/03/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | 321332-1205 | UT | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 60842 | 01 | UT | PUBLIC EMPLOYEES HEALTH P | OTHER | 187251500 | 01 | UT | US DEPT OF LABOR | OTHER | 841433992CO1 | 01 | UT | EDUCATORS MUTUAL | OTHER | 107007620101 | 01 | UT | SELECT HEALTH PLANS | OTHER | 09-00136 | 01 | UT | UNITED HEALTH CARE | OTHER | TPRA09041 | 01 | UT | MOLINA ADVANTAGE | OTHER |