Individual provider Active NPI

Dylan R Cooper

  • Family Medicine Physician
  • Biloxi, MS
National Provider Identifier
1063153682
Registry record updated Jan 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35790 Issued in MS
Practice address
400 Veterans Ave
Biloxi, MS 39531-2410
Phone
(228) 523-5000
NPI assigned
Apr 6, 2022
Last updated
Jan 28, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 28, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35790 MS Primary

Addresses

Primary practice location

400 Veterans Ave
Biloxi, MS 39531-2410

Mailing address

400 Veterans Ave
Biloxi, MS 39531-2410
Phone (228) 523-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220818000232 MS Order and Referring Only - Family PracticePractitioner - Family Practice 2264815679

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
35790MSMDFamily Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769558400000",
    "number": "1063153682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 VETERANS AVE",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395312410",
            "telephone_number": "228-523-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 VETERANS AVE",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395312410",
            "telephone_number": "228-523-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "DYLAN",
        "middle_name": "R",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-04-06",
        "last_updated": "2026-01-28",
        "certification_date": "2026-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "35790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Biloxi, MS

Sources for this page

Verify at the official NPI Registry.