Provider Demographics
NPI:1275731770
Name:COOPER, MICHAEL M (PA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:M
Last Name:COOPER
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:4881 NW 8TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4582
Mailing Address - Country:US
Mailing Address - Phone:352-416-1082
Mailing Address - Fax:352-373-6144
Practice Address - Street 1:4343 NEWBERRY RD
Practice Address - Street 2:SUITE 2
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2825
Practice Address - Country:US
Practice Address - Phone:352-373-2340
Practice Address - Fax:352-373-3140
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2024-05-24
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Provider Licenses
StateLicense IDTaxonomies
FLPA9101612363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113484200Medicaid