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NPI Code Detail

MEDICARE: SALLY A. COOPER D.O.

MEDICARE: SALLY A. COOPER D.O.
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
1207Q00000XFamily Medicine PhysicianOS9434FL
2207P00000XEmergency Medicine PhysicianOS9434FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2059197876OTHERALBCBS
328660OTHERFLBCBS
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487646725
Entity Type Code : Individual
Provider Name (Legal Business Name) : SALLY A. COOPER D.O.
Provider Business Mailing Address
First Line : 221 HOSPITAL DR NE
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32548-5066
Country : US
Telephone Number : 850-833-9240
Fax Number :
Provider Business Practice Location Address
First Line : 221 HOSPITAL DR NE
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32548-5066
Country : US
Telephone Number : 850-833-9240
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2005
Last Update Date : 07/28/2011

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Directions to “ SALLY A. COOPER D.O.” Practice Location

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