Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | MD00031024 | WA |
NPI | 1013092840 |
---|---|
Provider Name | Edus Houston Warren III |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98195-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 28/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0232145 | L&I (01) | WA |
1013092840 | (05) | WA |
2876 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
G61180 | (02) |