Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | OP60757160 | WA |
Y | 111NI0900X | Internist | OP60757160 | WA |
NPI | 1003235698 |
---|---|
Provider Name | Ali Ansary |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98195-2908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2014 |
Last Update Date | 10/12/2020 |