Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | ME114000 | FL |
NPI | 1023032307 |
---|---|
Provider Name | Dr. Brian W Cooper |
First Address | Jacksonville, FL 32216-4252 |
Second Address | Jacksonville, FL 32216-4252 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 16/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001229087 | MEDICARE ID (01) | FL |
E46260 | (02) | FL |