Individual
DR. KENNETH WAYNE KOOSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4800 COLLEGE ST SE, LACEY, WA 98503-4389
(360) 486-2900
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
(866) 366-2983
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD60320788
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306920772
—
UT
Enumeration date
10/24/2006
Last updated
06/16/2021
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