Provider Demographics
NPI:1235102641
Name:COPE, MIRIAM P (MD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:P
Last Name:COPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 100371
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0371
Mailing Address - Country:US
Mailing Address - Phone:352-338-2195
Mailing Address - Fax:352-338-2185
Practice Address - Street 1:3951 NW 48TH TER
Practice Address - Street 2:SUITE 101
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7229
Practice Address - Country:US
Practice Address - Phone:352-265-5230
Practice Address - Fax:352-265-5231
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME102521207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000129000Medicaid
FLAY644ZMedicare PIN