MEDICARE: HALLANDALE BEACH ORTHOPEDICS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XP3100X	Pediatric Orthopaedic Surgery Physician	OS4493	FL

General Provider Information

NPI Number	:	1144422486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALLANDALE BEACH ORTHOPEDICS, INC.

Provider Business Mailing Address
First Line	:	1250 E HALLANDALE BEACH BLVD STE 700
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4641
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 E HALLANDALE BEACH BLVD STE 700
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4641
Country	:	US
Telephone Number	:	954-456-3757
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HARRY COOPER
Credential	:	D.O
Telephone Number	:	954-456-3757

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	09/11/2012

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