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General NPI Number Information
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NPI Number | 1669704755
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Entity Type | Organization
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Legal Business Name | LOREN D COOPER, MD, INC. PS
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Dates
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Enumeration Date | 02/01/2010
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Last Update Date | 02/01/2010
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Provider Practice Location Address
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Address Line | 1800 COOKS HILL RD
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City | CENTRALIA
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State | WA
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Zip | 98531-9072
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Country | US
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Telephone | 360-330-8592
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Fax | 360-330-8617
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Provider Business Mailing Address
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Address Line | 1800 COOKS HILL RD
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City | CENTRALIA
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State | WA
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Zip | 98531-9072
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Country | US
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Telephone | 360-330-8592
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Fax | 360-330-8617
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Authorized Official
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Title or Position | PRESIDENT
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Name | LOREN D COOPER
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Credential | MD
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Telephone | 360-330-8591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 15204
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License Number State | WA
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