Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | MD00048526 | WA |
NPI | 1780872564 |
---|---|
Provider Name | Carter F. Yeatman II |
First Address | Lynnwood, WA 98036-4746 |
Second Address | Lynnwood, WA 98036-4746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2007 |
Last Update Date | 09/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1780872564 | (05) | ID |
248087 | L&I PROVIDER ID (01) | WA |
248107 | L&I PROVIDER ID (01) | WA |
8529893 | (05) | WA |