MEDICARE: DR. SHARRELL COOPER M.D

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	207Q00000X	Family Medicine Physician	ME 117633	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	:	1588094130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHARRELL COOPER M.D

Provider Business Mailing Address
First Line	:	1 MEMORIAL MEDICAL PKWY STE 201
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-5979
Country	:	US
Telephone Number	:	386-445-4750
Fax Number	:	386-445-4751

Provider Business Practice Location Address
First Line	:	1 MEMORIAL MEDICAL PKWY STE 201
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-5979
Country	:	US
Telephone Number	:	386-445-4750
Fax Number	:	386-445-4751

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

Provider Enumeration Date	:	11/18/2013
Last Update Date	:	02/08/2026

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