MEDICARE: DIANNE K WADE COOPER AU.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	231H00000X	Audiologist	AY99	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	:	1720250715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANNE K WADE COOPER AU.D.

Provider Business Mailing Address
First Line	:	17180 ROYAL PALM BLVD
Second Line	:	SUITE 1
City	:	WESTON
State	:	FL
Zip	:	33326-2394
Country	:	US
Telephone Number	:	954-389-1414
Fax Number	:	954-389-4201

Provider Business Practice Location Address
First Line	:	17180 ROYAL PALM BLVD
Second Line	:	SUITE 1
City	:	WESTON
State	:	FL
Zip	:	33326-2394
Country	:	US
Telephone Number	:	954-389-1414
Fax Number	:	954-389-4201

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

Provider Enumeration Date	:	03/31/2008
Last Update Date	:	04/05/2010

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