Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | MD00019632 | WA |
NPI | 1083775902 |
---|---|
Provider Name | Donald L Trippel |
First Address | Tacoma, WA 98415-0098 |
Second Address | Tacoma, WA 98405-2302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4337780 | AETNA (01) | WA |
8209942 | (05) | WA |
TR7403 | REGENCE BLUE CROSS SHIELD (01) | WA |