Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 00044072 | WA |
NPI | 1033216833 |
---|---|
Provider Name | Dr. William B. Ericson JR. |
First Address | Mountlake Terrace, WA 98043-2222 |
Second Address | Mountlake Terrace, WA 98043-2222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 17/08/2007 |