Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | OP60830303 | WA |
NPI | 1114285707 |
---|---|
Provider Name | Daniel Augusten Carr |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2012 |
Last Update Date | 13/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1114285707 | (05) | WA |