Provider Demographics
NPI:1992716849
Name:COOLEY, ROXANA GABRIELA (MD)
Entity type:Individual
Prefix:DR
First Name:ROXANA
Middle Name:GABRIELA
Last Name:COOLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NE MULTNOMAH ST
Mailing Address - Street 2:SUITE100
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2099
Mailing Address - Country:US
Mailing Address - Phone:503-813-3480
Mailing Address - Fax:503-813-3555
Practice Address - Street 1:500 NE MULTNOMAH ST
Practice Address - Street 2:SUITE100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2099
Practice Address - Country:US
Practice Address - Phone:503-813-3480
Practice Address - Fax:503-813-3555
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043375207L00000X
ORMD 150194207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8382814Medicaid
8802904Medicare ID - Type Unspecified
WA8382814Medicaid