Provider Demographics
NPI:1649859950
Name:COOPER, BENJAMIN WILLIAM (DO)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:WILLIAM
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 1:625 E TWIGGS ST STE 103
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-3910
Mailing Address - Country:US
Mailing Address - Phone:813-228-7696
Mailing Address - Fax:813-228-0677
Practice Address - Street 1:625 E TWIGGS ST STE 103
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-3910
Practice Address - Country:US
Practice Address - Phone:813-228-7696
Practice Address - Fax:813-228-0677
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS19475208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation