Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | MD00037264 | WA |
NPI | 1003925785 |
---|---|
Provider Name | Dr. Ted M Zollman |
First Address | Seattle, WA 98104-1306 |
Second Address | Seattle, WA 98104-1306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 20/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0129181 | L&I (01) | WA |
8240814 | (05) | WA |
G92511 | (02) |