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General NPI Number Information
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NPI Number | 1578755211
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Entity Type | Organization
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Legal Business Name | COOPER UROLOGY, INC. PS
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 08/16/2007
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Provider Practice Location Address
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Address Line | 1611 BUCK WAY
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City | MOUNT VERNON
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State | WA
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Zip | 98273-2596
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Country | US
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Telephone | 360-424-2180
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Fax | 360-428-3675
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Provider Business Mailing Address
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Address Line | 1611 BUCK WAY
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City | MOUNT VERNON
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State | WA
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Zip | 98273-2596
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Country | US
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Telephone | 360-424-2180
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Fax | 360-428-3675
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Authorized Official
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Title or Position | MANAGER
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Name | LAURIE PRESTON
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Credential |
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Telephone | 360-424-2180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MD00013050
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License Number State | WA
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