MEDICARE: DR. ROXANA GABRIELA COOLEY 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	207L00000X	Anesthesiology Physician	MD00043375	WA
2	207L00000X	Anesthesiology Physician	MD 150194	OR

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	:	1992716849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROXANA GABRIELA COOLEY MD

Provider Business Mailing Address
First Line	:	500 NE MULTNOMAH ST
Second Line	:	SUITE100
City	:	PORTLAND
State	:	OR
Zip	:	97232-2099
Country	:	US
Telephone Number	:	503-813-3480
Fax Number	:	503-813-3555

Provider Business Practice Location Address
First Line	:	500 NE MULTNOMAH ST
Second Line	:	SUITE100
City	:	PORTLAND
State	:	OR
Zip	:	97232-2099
Country	:	US
Telephone Number	:	503-813-3480
Fax Number	:	503-813-3555

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	02/04/2022

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