Idalis Inc

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

06-00027820 Issued in WA

Legal business name

IDALIS INC

Practice address

3663 College St SE Ste a
Lacey, WA 98503-3529

Phone

(360) 413-1728

Fax

(360) 413-1669

NPI assigned

Jul 15, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Samuel E Coor, DO

Title

Owner

Phone

(360) 413-1728

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197244800000",
    "number": "1184640591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3663 COLLEGE ST SE STE A",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985033529",
            "telephone_number": "360-413-1728",
            "fax_number": "360-413-1669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3663 COLLEGE ST SE STE A",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985033529",
            "telephone_number": "360-413-1728",
            "fax_number": "360-413-1669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDALIS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2007-12-10",
        "status": "A",
        "authorized_official_last_name": "COOR",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-413-1728",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WA",
            "license": "06-00027820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Neurology Physician in Lacey, WA
• Providers in Lacey, WA by specialty
• Neurology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.