Provider Demographics
NPI:1558343244
Name:COOPER, CATHERINE M (DO)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:M
Last Name:COOPER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5123 4TH AVENUE CIR E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-5620
Mailing Address - Country:US
Mailing Address - Phone:941-744-5510
Mailing Address - Fax:941-744-5166
Practice Address - Street 1:5123 4TH AVENUE CIR E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-5620
Practice Address - Country:US
Practice Address - Phone:941-744-5510
Practice Address - Fax:941-744-5166
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8143207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI13798Medicare UPIN
FL48046ZMedicare ID - Type Unspecified