Provider Demographics
NPI:1528225810
Name:COOPER, JOSHUA M (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:M
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1536 N 115TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8400
Mailing Address - Country:US
Mailing Address - Phone:206-368-1160
Mailing Address - Fax:206-368-1159
Practice Address - Street 1:1536 N 115TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8400
Practice Address - Country:US
Practice Address - Phone:206-368-1160
Practice Address - Fax:206-368-1159
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD600030342086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD60003034OtherWA STATE DOH