Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 01060555A | IN |
N | 111NI0900X | Internist | 01060555A | IN |
N | 207R00000X | Internist | E-6087 | AR |
N | 111NI0900X | Internist | E-6087 | AR |
N | 207RC0000X | Internist - Cardiovascular Disease | E-6087 | AR |
Y | 207RI0011X | Interventional Cardiology | MD60590251 | WA |
NPI | 1073587614 |
---|---|
Provider Name | Dr. Freij Antoine Gobal |
First Address | Burien, WA 98166-3045 |
Second Address | Burien, WA 98166-3045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 31/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
185115001 | (05) | AR |
200527190 | (05) | IN |
356022 | STATE L&I (01) | WA |
I33420 | (02) | IN |
P00225443 | RAILROAD MEDICARE (01) | IN |