Provider Demographics
NPI:1871646075
Name:KOSS, RICHARD WESLEY (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:WESLEY
Last Name:KOSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22142 SE 237TH ST.
Mailing Address - Street 2:SUITE #8
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-6405
Mailing Address - Country:US
Mailing Address - Phone:425-433-6073
Mailing Address - Fax:425-433-6074
Practice Address - Street 1:22142 SE 237TH ST.
Practice Address - Street 2:SUITE #8
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-6405
Practice Address - Country:US
Practice Address - Phone:425-433-6073
Practice Address - Fax:425-433-6074
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP000989204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA125824OtherLABOR & INDUSTRIES