| Organization Name: | FORT WAYNE ORTHOPEDICS, LLC |
| NPI Number: | 1043525009 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JERALD L. COOPER (M.D./PRESIDENT) |
| Mailing Address: | 315 W Old Key Dr Suite 140 Peru |
| State: | IN US |
| Postal Code: | 469709058 |
| Phone Number: | 2604368686 |
| Fax Number: | 2604590036 |
| NPI Enumeration Date: | 08/16/2010 |
| NPI Last Update Date: | 11/27/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207XS0106X |
| License Number: | 50002482 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Orthopaedic Surgery |
| Taxonomy Specialization: | Hand Surgery |
| Taxonomy Definition: | An orthopaedic surgeon trained in the investigation, preservation and restoration by medical, surgical and rehabilitative means of all structures of the upper extremity directly affecting the form and function of the hand and wrist. |