Organization
FORT WAYNE ORTHOPAEDICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERALD L COOPER M.D. (PRESIDENT)
(260) 436-8686
Entity
Organization
Contact information
Practice address
7601 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4133
(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
50002482A
IN
207XS0106X
Orthopaedic Hand Surgery Physician
50002482
IN
207XS0117X
Orthopaedic Surgery of the Spine Physician
50002482
IN
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
50002482
IN
207XX0801X
Orthopaedic Trauma Physician
50002482
IN
213E00000X
Podiatrist
50002482
IN
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
363A00000X
Physician Assistant
50002482A
IN
363L00000X
Nurse Practitioner
50002482A
IN
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201255250
—
IN
Enumeration date
05/23/2005
Last updated
11/19/2015
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