MEDICARE: BRITTANY RAISA COOLS-LARTIGUE MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	MD61255592	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093276552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY RAISA COOLS-LARTIGUE MD

Provider Business Mailing Address
First Line	:	4550 FAUNTLEROY WAY SW STE 100
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-3471
Country	:	US
Telephone Number	:	206-933-1041
Fax Number	:	206-933-1047

Provider Business Practice Location Address
First Line	:	4550 FAUNTLEROY WAY SW STE 100
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-3471
Country	:	US
Telephone Number	:	206-933-1041
Fax Number	:	206-933-1047

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2019
Last Update Date	:	01/05/2023

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