Clifford Cooper, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9101412 Issued in FL

Practice address

110 Longwood Avenue
Rockledge, FL 32955-2828

Phone

(800) 476-8646

Fax

(919) 382-3210

NPI assigned

Jun 1, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brevard Emergency Services

  • Internal Medicine Physician
  • Melbourne, FL
  • NPI 1104870393
  NPD (past)
• Wuesthoff Emergency Physicians PA

  • Emergency Medicine Physician
  • Rockledge, FL
  • NPI 1831192244
  NPD (past)
• Wuesthoff Emergency Physicians-Melbourne PA

  • Emergency Medicine Physician
  • Melbourne, FL
  • NPI 1508868886
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216080000000",
    "number": "1477555746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30731",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336303731",
            "telephone_number": "800-476-8646",
            "fax_number": "919-382-3210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 LONGWOOD AVENUE",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329552828",
            "telephone_number": "800-476-8646",
            "fax_number": "919-382-3210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "CLIFFORD",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2008-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9101412",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291562600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Community Access to Child Health of Brevard, Inc.
• Community Access to Child Health of Brevard, Inc.
• Compassionate Counseling of Florida, Inc
• Connected Thriving Counseling and Wellness
• Connections for Autism
• Cora Health Services Inc
• Yong Son Corcoran
• Kacy-Ann Cordiel, APRN
• Core Connections FL
• Core Connections, Inc

• Physician Assistant in Rockledge, FL
• Providers in Rockledge, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.