Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 00015414 | WA |
NPI | 1386636934 |
---|---|
Provider Name | David L Heard |
First Address | Edmonds, WA 98026-8047 |
Second Address | Edmonds, WA 98026-8012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 01/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
18297 | WORKER'S COMP (01) | WA |
1922905 | (05) | WA |
AO6312 | (02) | WA |