Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MD00019644 | WA |
N | 207VX0000X | Obstetrician | MD00019644 | WA |
NPI | 1356487029 |
---|---|
Provider Name | Dana Blackham |
First Address | Seattle, WA 98117-2000 |
Second Address | Seattle, WA 98117-2000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 17/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1940105 | (05) | WA |
B398 | PREMERA BLUE CROSS (01) | WA |
B398 | REGENCE BLUE SHIELD (01) | WA |
G000100486 | (02) | WA |