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General NPI Number Information
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NPI Number | 1033226154
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Entity Type | Individual
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Provider Name | ALAN S. COOPERMAN D.O.
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Gender | Male
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 14110 SPRING HOLLOW RD
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City | FORT WAYNE
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State | IN
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Zip | 46814-9767
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Country | US
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Telephone | 260-672-3121
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Fax |
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Provider Business Mailing Address
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Address Line | 14110 SPRING HOLLOW RD
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City | FORT WAYNE
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State | IN
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Zip | 46814-9767
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Country | US
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Telephone | 260-672-3121
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 02000572A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 34002606
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 32745
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 43169
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License Number State | CO
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 3070
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License Number State | AZ
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Taxonomy #6
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A-1313-05
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License Number State | NM
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