Provider Demographics
NPI:1982832218
Name:ALEX D. COOPER, MD, PLLC
Entity Type:Organization
Organization Name:ALEX D. COOPER, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:D
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-365-0111
Mailing Address - Street 1:1570 N 115TH ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8412
Mailing Address - Country:US
Mailing Address - Phone:206-365-0111
Mailing Address - Fax:206-365-2980
Practice Address - Street 1:1570 N 115TH ST
Practice Address - Street 2:SUITE 14
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8412
Practice Address - Country:US
Practice Address - Phone:206-365-0111
Practice Address - Fax:206-365-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD600717962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN849495900Medicaid
MN849495900Medicaid
130001235Medicare PIN