Organization
FORT WAYNE ORTHOPAEDICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERALD L COOPER M.D, (PRESIDENT)
(260) 436-8686
Entity
Organization
Contact information
Practice address
410 N WILLOWBROOK RD, COLDWATER, MI 49036-9462
(260) 436-8686
(260) 436-8585
Mailing address
PO BOX 2526, FORT WAYNE, IN 46801-2526
(260) 436-8686
(260) 436-8585
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XS0106X
Orthopaedic Hand Surgery Physician
—
—
207XS0117X
Orthopaedic Surgery of the Spine Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
207XX0801X
Orthopaedic Trauma Physician
—
—
213E00000X
Podiatrist
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100210470
—
IN
Enumeration date
09/01/2010
Last updated
09/01/2010
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