Provider Demographics
NPI:1902809106
Name:COOPER, HOMI S (MD)
Entity Type:Individual
Prefix:DR
First Name:HOMI
Middle Name:S
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:805 CENTURY MEDICAL DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796
Mailing Address - Country:US
Mailing Address - Phone:321-633-8650
Mailing Address - Fax:321-633-8651
Practice Address - Street 1:390 CHALLENGER ROAD
Practice Address - Street 2:
Practice Address - City:CAPE CANAVERAL
Practice Address - State:FL
Practice Address - Zip Code:32920
Practice Address - Country:US
Practice Address - Phone:321-633-8650
Practice Address - Fax:321-633-8651
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME695132083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251596200Medicaid
FL32439ZMedicare ID - Type Unspecified
FLE63590Medicare UPIN