Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | G76695 | CA |
Y | 2080P0205X | Pediatric Endocrinologist | G76695 | CA |
NPI | 1053482810 |
---|---|
Provider Name | Eric Anthony Simone |
First Address | Seattle, WA 98104-1306 |
Second Address | Seattle, WA 98104-1306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 28/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G766950 | (05) | CA |
F82278 | (02) | CA |