Provider Demographics
NPI:1407893969
Name:KOPP, STANLEY ALBERT (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:ALBERT
Last Name:KOPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1302
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-1302
Mailing Address - Country:US
Mailing Address - Phone:425-514-8070
Mailing Address - Fax:425-710-0332
Practice Address - Street 1:12911 120TH AVE NE
Practice Address - Street 2:SUITE C-50
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3027
Practice Address - Country:US
Practice Address - Phone:425-823-1052
Practice Address - Fax:425-899-4243
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025061207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1109636Medicaid
WA1109636Medicaid
WAGAB26434Medicare PIN