Organization
IDALIS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL E COOR DO (OWNER)
(360) 413-1728
Entity
Organization
Contact information
Practice address
3663 COLLEGE ST SE STE A, LACEY, WA 98503-3529
(360) 413-1728
(360) 413-1669
Mailing address
3663 COLLEGE ST SE STE A, LACEY, WA 98503-3529
(360) 413-1728
(360) 413-1669
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
06-00027820
WA
Other
Enumeration date
07/15/2006
Last updated
12/10/2007
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