Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | MD00045899 | WA |
NPI | 1053409912 |
---|---|
Provider Name | Eric Cooper |
First Address | Seattle, WA 98117-3235 |
Second Address | Everett, WA 98201-1665 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8444390 | (05) | WA |
G68066 | (02) | WA |