Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD60774388 | WA |
NPI | 1124022983 |
---|---|
Provider Name | Dr. Broadus Zane Atkins |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98195-1418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 26/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1124022983 | (05) | WA |
8971060 | MEDICARE PIN (01) | WA |
I05953 | (02) | NC |