Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 601484763 | WA |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD00044729 | WA |
NPI | 1316987803 |
---|---|
Provider Name | Anthony Beaumont Van Bergeyk |
First Address | Seattle, WA 98104-1172 |
Second Address | Puyallup, WA 98374-2106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 19/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H45723 | (02) |