Provider Demographics
NPI:1730717075
Name:COOPER, JOSHUA ADAM (DO)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:ADAM
Last Name:COOPER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 FALLEN TIMBERS DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2298
Mailing Address - Country:US
Mailing Address - Phone:904-860-0822
Mailing Address - Fax:
Practice Address - Street 1:557 FALLEN TIMBERS DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2298
Practice Address - Country:US
Practice Address - Phone:904-860-0822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program