Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | MD00048328 | WA |
NPI | 1093919698 |
---|---|
Provider Name | Benjamin Killey |
First Address | Chicago, IL 60640-1957 |
Second Address | Everett, WA 98201-1665 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BK9674878 | DEA (01) | WA |