Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 025209 | WA |
N | 111NI0900X | Internist | 025209 | WA |
N | 207RC0000X | Internist - Cardiovascular Disease | 025208 | WA |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 025209 | WA |
NPI | 1063533115 |
---|---|
Provider Name | Dr. Gust H. Bardy |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98195-6422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 06/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063533115 | (05) | WA |
A04030 | (02) | WA |