Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 14463 | WA |
NPI | 1023169372 |
---|---|
Provider Name | Dr. William Roby Pace III |
First Address | Ellensburg, WA 98926-3885 |
Second Address | Ellensburg, WA 98926-3885 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1139203 | (05) | WA |
A07636 | (02) | WA |