Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 01055856A | IN |
NPI | 1376500579 |
---|---|
Provider Name | Dr. Jonathan Merlin Davison |
First Address | Tacoma, WA 98431-0001 |
Second Address | Tacoma, WA 98431-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 14/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01055856A | PHYSICIAN LICENSE (01) | IN |