Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 227104 | MA |
N | 111NI0900X | Internist | 227104 | MA |
Y | 207R00000X | Internist | MD00049111 | WA |
Y | 111NI0900X | Internist | MD00049111 | WA |
N | 207RG0300X | Geriatric Medicine | MD00049111 | WA |
NPI | 1063470037 |
---|---|
Provider Name | Arnulfo T Deray |
First Address | Richland, WA 99352 |
Second Address | Richland, WA 99352-3514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 24/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0242332 | LABOR & INDUSTRIES (01) | WA |
8509499 | (05) | WA |