Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | MD60205278 | WA |
NPI | 1417978651 |
---|---|
Provider Name | Edward Libby |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98109-4405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2006 |
Last Update Date | 04/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0276849 | L&I (01) | WA |
1417978651 | (05) | WA |