Provider Demographics
NPI:1316998867
Name:COOPERMAN, ELLIOT W (MD)
Entity type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:W
Last Name:COOPERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ELLIOT
Other - Middle Name:W
Other - Last Name:COOPERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:311 E EVANS ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4613
Mailing Address - Country:US
Mailing Address - Phone:407-898-6091
Mailing Address - Fax:407-896-3452
Practice Address - Street 1:311 E EVANS ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4613
Practice Address - Country:US
Practice Address - Phone:407-898-6091
Practice Address - Fax:407-896-3452
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0034891207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032439411013OtherCIGNA
FL4008330OtherAETNA PPO/PPS
FL065572400Medicaid
FL0052241OtherGHI
FL0004355807OtherHUMANA
FL180000687OtherRAIL ROAD MEDICARE
FL898092OtherAETNA HMO
FL4008330OtherAETNA PPO/PPS
FLG55050Medicare UPIN