Doctor Name: | BRENT D. KOOY |
NPI Number: | 1033261458 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.A. |
License Number: | PA10004744 |
Business Practice Address: | 2700 152nd Ave Ne Redmond, WA - 980525543 |
Business Phone Number: | 4258835151 |
Business Fax Number: | |
Mailing Address: | Po Box 34584, SEATTLE |
State: | WA |
Postal Code: | 981241584 |
Phone Number: | 5092417349 |
Fax Number: | 5092417628 |
NPI Enumeration Date: | 01/17/2007 |
NPI Last Update Date: | 05/12/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | PA10004744 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |