Provider Demographics
NPI:1023010006
Name:COOPERSTEIN, GARY ALAN (DO)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:ALAN
Last Name:COOPERSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14826 S MILITARY TRL STE 14826
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8153
Mailing Address - Country:US
Mailing Address - Phone:561-496-5677
Mailing Address - Fax:
Practice Address - Street 1:14826 S MILITARY TRL STE 14826
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8153
Practice Address - Country:US
Practice Address - Phone:561-496-5677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-005991-L207Q00000X
FLOS15659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00617284OtherRAILROAD MEDICARE
PA0372127001OtherKEYSTONE PROVIDER ID
PAP2381468OtherOXFORD
PA168000OtherBLUE CROSS NUMBER
PA847OtherAETNA ID NUMBER
PA847OtherAETNA ID NUMBER
PAP2381468OtherOXFORD
PA0372127001OtherKEYSTONE PROVIDER ID