Provider Demographics
NPI:1487647921
Name:COOP, CHRISTOPHER MICHAEL (DPM)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:COOP
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 SE 177TH AVE
Mailing Address - Street 2:UNIT 386
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4217
Mailing Address - Country:US
Mailing Address - Phone:360-693-1820
Mailing Address - Fax:360-693-6940
Practice Address - Street 1:455 SE 177TH AVE
Practice Address - Street 2:UNIT 386
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4217
Practice Address - Country:US
Practice Address - Phone:360-693-1820
Practice Address - Fax:360-693-6940
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO649213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7121213Medicaid
U76526Medicare UPIN
WA7121213Medicaid