Cooper, Jerald L

Cooper, Jerald L is an individual health care provider with primary practice located at 7601 W Jefferson Blvd , Fort Wayne IN 46804-4133. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Cooper, Jerald L can be contacted via phone (260) 436-8686.

Contact Information

Primary practice address
7601 W Jefferson Blvd Fort Wayne IN 46804-4133
Phone: (260) 436-8686
Fax: (260) 436-8585
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207XX0005X 01041661A Indiana

Profile Details

NPI number 1598768566
LBN Legal business name Cooper, Jerald L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 24th, 2005
Last updated Nov 7th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598768566 NPPES
Other 00000089395 ANTHEM
MEDICAID 100340100A ANTHEM
Other 200015791 ANTHEM

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