Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | GA10000334 | WA |
N | 1223G0001X | General Practice | DE00007758 | WA |
N | 213EG0000X | General Practice | DE00007758 | WA |
NPI | 1659590206 |
---|---|
Provider Name | Dr. Eugene Benjamin Pester |
First Address | Moses Lake, WA 98837-1948 |
Second Address | Moses Lake, WA 98837-1948 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 11/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5024930 | (05) | WA |