Provider Demographics
NPI:1023010006
Name:COOPERSTEIN, GARY ALAN (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ALAN
Last Name:COOPERSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COCONUT CREEK PLAZA
Mailing Address - Street 2:4450 FL-7 #1
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073
Mailing Address - Country:US
Mailing Address - Phone:954-633-1422
Mailing Address - Fax:
Practice Address - Street 1:COCONUT CREEK PLAZA
Practice Address - Street 2:4450 FL-7 #1
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3382
Practice Address - Country:US
Practice Address - Phone:610-873-2155
Practice Address - Fax:610-873-8494
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-005991-L207Q00000X
FLOS15659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA847OtherAETNA ID NUMBER
PAP2381468OtherOXFORD
PA0372127001OtherKEYSTONE PROVIDER ID
PA168000OtherBLUE CROSS NUMBER
PAP00617284OtherRAILROAD MEDICARE
PA847OtherAETNA ID NUMBER
PAP2381468OtherOXFORD
PA0372127001OtherKEYSTONE PROVIDER ID