Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | MD00047683 | WA |
Y | 213ES0000X | Sports Medicine | MD00047683 | WA |
NPI | 1053352708 |
---|---|
Provider Name | Brian J Krabak |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98195-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 17/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0231416 | L&I (01) | WA |
1053352708 | (05) | WA |
G52499 | (02) | MD |