Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | MD00028670 | WA |
NPI | 1386730471 |
---|---|
Provider Name | David Ricker |
First Address | Tacoma, WA 98405 |
Second Address | Tacoma, WA 98405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 21/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1067776 | (05) | WA |
F10546 | (02) |