Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO00000450 | WA |
Y | 222Z00000X | Podiatrist | PO00000450 | WA |
NPI | 1033202593 |
---|---|
Provider Name | Dr. Rockwell G Moulton |
First Address | Seattle, WA 98165 |
Second Address | Seattle, WA 98115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 20/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1098680 | (05) | WA |
374710001 | GROUP HEALTH (01) | WA |
911730720 | TAX ID (01) | WA |
MO6117 | BLUE CROSS (01) | WA |
U11308 | (02) | WA |