Provider Demographics
NPI:1528137759
Name:COOPER, WALTER THOMAS III (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:THOMAS
Last Name:COOPER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1200 N 14TH AVE
Mailing Address - Street 2:SUITE 245
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-4182
Mailing Address - Country:US
Mailing Address - Phone:509-547-9521
Mailing Address - Fax:509-547-5983
Practice Address - Street 1:1200 N 14TH AVE
Practice Address - Street 2:SUITE 245
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4182
Practice Address - Country:US
Practice Address - Phone:509-547-9521
Practice Address - Fax:509-547-5983
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2008-01-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00020136207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1377100Medicaid
WA1377100Medicaid