Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | MTS 4427 | WA |
NPI | 1851349625 |
---|---|
Provider Name | Dr. Bassem Bejjani |
First Address | Spokane, WA 99204-2306 |
Second Address | Spokane, WA 99204-2306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G81357 | (02) | WA |