Provider Demographics
NPI:1841240173
Name:COOPER, ROBERT NATHAN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:NATHAN
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 S CENTRAL BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7395
Mailing Address - Country:US
Mailing Address - Phone:561-741-9000
Mailing Address - Fax:772-288-6666
Practice Address - Street 1:1680 S CENTRAL BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7395
Practice Address - Country:US
Practice Address - Phone:561-741-9000
Practice Address - Fax:772-288-6666
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39155208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43089Medicare ID - Type Unspecified
FLD54860Medicare UPIN