Provider Demographics
NPI:1407856222
Name:COOPER, JONATHAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:D
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15280 NW 79TH CT STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5873
Mailing Address - Country:US
Mailing Address - Phone:305-558-3724
Mailing Address - Fax:786-907-4485
Practice Address - Street 1:2500 WESTON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3615
Practice Address - Country:US
Practice Address - Phone:954-389-1414
Practice Address - Fax:954-389-4201
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME56192207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374640200Medicaid
FL374640200Medicaid