Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 8967 | WA |
NPI | 1124063557 |
---|---|
Provider Name | Dr. Edwin Chamberlayne Brockenbrough |
First Address | Hunts Point, WA 98004-1114 |
Second Address | Hunts Point, WA 98004-1114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 29/08/2007 |