Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD00025177 | WA |
NPI | 1003969783 |
---|---|
Provider Name | David A Remis |
First Address | Seattle, WA 98124-1584 |
Second Address | Olympia, WA 98506-5115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 06/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1007004 | (05) | WA |
C94491 | (02) | WA |