Provider Demographics
NPI:1588634935
Name:COOPER, JEFF (DO PLLC)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:DO PLLC
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Mailing Address - Street 1:4300 TALBOT RD S
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6238
Mailing Address - Country:US
Mailing Address - Phone:425-228-1123
Mailing Address - Fax:425-228-5791
Practice Address - Street 1:4300 TALBOT ROAD S
Practice Address - Street 2:SUITE 104
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5767
Practice Address - Country:US
Practice Address - Phone:425-228-1123
Practice Address - Fax:425-228-5791
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2015-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAOP00001995208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8863962OtherMEDICARE ID-PIN
WA8429854Medicaid
WAI36101Medicare UPIN