MEDICARE: JEFF COOPER DO PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	OP00001995	WA

General Provider Information

NPI Number	:	1275673956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFF COOPER DO PLLC

Provider Business Mailing Address
First Line	:	4300 TALBOT ROAD S
Second Line	:	SUITE 104
City	:	RENTON
State	:	WA
Zip	:	98055-5767
Country	:	US
Telephone Number	:	425-228-1123
Fax Number	:	425-228-5791

Provider Business Practice Location Address
First Line	:	4300 TALBOT ROAD S
Second Line	:	SUITE 104
City	:	RENTON
State	:	WA
Zip	:	98055-5767
Country	:	US
Telephone Number	:	425-228-1123
Fax Number	:	833-973-3950

Authorized Official
Title or Position	:	MANAGER/BILLER
Name	:	MS. ANA DE GUZMAN
Credential	:	DO
Telephone Number	:	206-766-0613

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	04/10/2025

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