Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD00028221 | WA |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD00028221 | WA |
NPI | 1194728709 |
---|---|
Provider Name | Dr. Michael E Brage |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98104-2433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 12/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0275659 | L&I PROVIDER NUMBER (01) | WA |
1194728709 | (05) | WA |
F04547 | (02) | CA |