Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 0000978 | WA |
NPI | 1851468144 |
---|---|
Provider Name | Dr. Frederick W Bomonti III |
First Address | Puyallup, WA 98373-0910 |
Second Address | Puyallup, WA 98373-3678 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/07/2007 |