Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | L0103 | TX |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | OP00002026 | WA |
NPI | 1215956024 |
---|---|
Provider Name | David Coons |
First Address | Tacoma, WA 98405-2433 |
Second Address | Tacoma, WA 98405-2433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 21/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0069KA | BCBS (01) | TX |
134307113 | (05) | TX |
H09370 | (02) |