Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | MD60221637 | WA |
NPI | 1043423775 |
---|---|
Provider Name | Ahmad Mahallati-Shirazi |
First Address | Seattle, WA 98111 |
Second Address | Seattle, WA 98101-2756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 25/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043423775 | (05) | WA |
413127400 | (05) | MD |
925031-01 | BLUE CROSS/BLUE SHIELD (01) | MD |
P00981400 | RAILROAD MEDICARE (01) | WA |
S062-0323 | BLUE CROSS/BLUE SHIELD REGIONAL (01) | MD |