Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD00030256 | WA |
N | 207Q00000X | Family Doctor | MD00030256 | WA |
NPI | 1013053107 |
---|---|
Provider Name | Bev-Lorraine Bergman True |
First Address | Seattle, WA 98124-1584 |
Second Address | Tukwila, WA 98168-2558 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 09/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8196495 | (05) | WA |
G33414 | (02) | WA |