Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | OP00001308 | WA |
NPI | 1073549002 |
---|---|
Provider Name | Dr. John D Patz |
First Address | Monroe, WA 98272-1127 |
Second Address | Monroe, WA 98272-1127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 06/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E^3656 | (02) |