Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | PO00000731 | WA |
NPI | 1396820536 |
---|---|
Provider Name | Chad Farley |
First Address | Lakewood, WA 98499-3024 |
Second Address | Lakewood, WA 98499-3024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 10/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0219604 | L & I (01) | WA |
203641 | L & I (01) | WA |
8441636 | (05) | WA |
8940615 | CRIME VICTIMS (01) | WA |
8944020 | CRIME VICTIMS (01) | WA |
P00345477 | RAILROAD (01) | WA |
V01320 | (02) | WA |