Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | OP00001162 | WA |
Y | 213ES0000X | Sports Medicine | OP00001162 | WA |
NPI | 1013954841 |
---|---|
Provider Name | Davis Charles Pitt |
First Address | Seattle, WA 98107-3845 |
Second Address | Seattle, WA 98107-3845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8182990 | (05) | WA |
E33745 | (02) | WA |