Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 25209 | WA |
NPI | 1306845953 |
---|---|
Provider Name | Bruce R Gilbert |
First Address | Federal Way, WA 98093-3730 |
Second Address | Auburn, WA 98001-4939 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1024611 | (05) | WA |
A06174 | (02) | WA |