Provider Demographics
NPI:1023032307
Name:COOPER, BRIAN W (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:W
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3599 UNIVERSITY BLVD S
Mailing Address - Street 2:BLDG. 500, STE. 504
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4252
Mailing Address - Country:US
Mailing Address - Phone:904-398-5614
Mailing Address - Fax:904-398-5617
Practice Address - Street 1:3599 UNIVERSITY BLVD S
Practice Address - Street 2:BLDG. 500, STE. 504
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4252
Practice Address - Country:US
Practice Address - Phone:904-398-5614
Practice Address - Fax:904-398-5617
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-04-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME114000207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001229087OtherMEDICARE ID
FL001229087OtherMEDICARE ID