Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | MD00017432 | WA |
N | 207QA0505X | Family Doctor - Adult Medicine | MD00017432 | WA |
N | 207QS0010X | Family Doctor - Sports Medicine | MD00017432 | WA |
N | 2081S0010X | Sports Medicine | MD00017432 | WA |
N | 213ES0000X | Sports Medicine | MD00017432 | WA |
NPI | 1063441236 |
---|---|
Provider Name | Dr. Thomas Gerald Depuydt |
First Address | Kirkland, WA 98034-7500 |
Second Address | Kirkland, WA 98034-7500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A04372 | (02) | WA |