Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD00046230 | WA |
Y | 207QS0010X | Family Doctor - Sports Medicine | MD00046230 | WA |
NPI | 1013097096 |
---|---|
Provider Name | Ashwin Laxminarayana Rao |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98195-4770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 05/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013097096 | (05) | WA |
305970 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
I52012 | (02) |