Organization
FORT WAYNE ORTHOPAEDICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERALD L. COOPER M.D. (M.D./PRESIDENT)
(260) 436-8686
Entity
Organization
Contact information
Practice address
2512 E DUPONT RD, SUITE 110, FORT WAYNE, IN 46825-1609
(260) 436-8686
(260) 436-8585
Mailing address
PO BOX 2526, FORT WAYNE, IN 46801-2526
(260) 436-8686
(260) 432-5075
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
50002482
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
213ES0131X
Foot Surgery Podiatrist
50002482
IN
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
50002482A
IN
363A00000X
Physician Assistant
50002482
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0162610002
DME PTAN
IN
05
—
100210470
—
IN
05
—
100210470A
—
IN
Enumeration date
08/13/2010
Last updated
12/04/2018
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