Individual
JERALD L COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
01041661A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000089395
ANTHEM
—
05
—
100340100A
—
IN
01
—
200015791
RAILROAD MEDICARE
—
Enumeration date
05/24/2005
Last updated
11/07/2016
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us