Provider Demographics
NPI:1871513192
Name:COOPER FAMILY MEDICAL PLLC
Entity Type:Organization
Organization Name:COOPER FAMILY MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-744-5510
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 1:5101 4TH AVENUE CIR E
Practice Address - Street 2:SUITE 200
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-5630
Practice Address - Country:US
Practice Address - Phone:941-744-5510
Practice Address - Fax:941-744-5166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74797OtherBLUE CROSS BLUE SHIELD
FLK5950Medicare ID - Type UnspecifiedMEDICARE