Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | MD00011188 | WA |
NPI | 1609952456 |
---|---|
Provider Name | Charles H Chesnut III |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98105-4740 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 30/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110075127 | RAILROAD MEDICARE (01) | WA |
1152206 | (05) | WA |
1153 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
E27417 | (02) |