Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301098632 | MI |
N | 208600000X | Surgeon | 4301098632 | MI |
Y | 208200000X | Surgeon | MD60779039 | WA |
Y | 208600000X | Surgeon | MD60779039 | WA |
NPI | 1013203082 |
---|---|
Provider Name | Dr. Deepali Jain |
First Address | Gig Harbor, WA 98332-5817 |
Second Address | Gig Harbor, WA 98332-5817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2011 |
Last Update Date | 04/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2087508 | (05) | WA |