Healthcare Provider Details

I. General information

NPI: 1093903700
Provider Name (Legal Business Name): DANIEL HARRISON COPP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 S OTHELLO ST
SEATTLE WA
98118-3510
US

IV. Provider business mailing address

3849 CASCADIA AVE S
SEATTLE WA
98118-1128
US

V. Phone/Fax

Practice location:
  • Phone: 206-788-3500
  • Fax:
Mailing address:
  • Phone: 206-518-2653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60094853
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: