Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | CH60880594 | WA |
NPI | 1255819769 |
---|---|
Provider Name | Dr. Peter Harold Devries JR. |
First Address | Anacortes, WA 98221-3489 |
Second Address | Anacortes, WA 98221-3489 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2018 |
Last Update Date | 06/08/2018 |