Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | D54108 | MD |
Y | 2080P0214X | Pediatric Pulmonologist | MD00046647 | WA |
NPI | 1609811744 |
---|---|
Provider Name | Benjamin Wilfond |
First Address | Seattle, WA 98105-1010 |
Second Address | Seattle, WA 98105-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 23/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
575001600 | (05) | MD |
E78005 | (02) | MD |