MEDICARE: DR. JONATHAN D COOPER MD

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	207Y00000X	Otolaryngology Physician	ME56192	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407856222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN D COOPER MD

Provider Business Mailing Address
First Line	:	15280 NW 79TH CT STE 200
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5873
Country	:	US
Telephone Number	:	305-558-3724
Fax Number	:	786-907-4485

Provider Business Practice Location Address
First Line	:	2500 WESTON RD
Second Line	:	SUITE 103
City	:	WESTON
State	:	FL
Zip	:	33331-3615
Country	:	US
Telephone Number	:	954-389-1414
Fax Number	:	954-389-4201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	09/20/2022

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