Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO60394257 | WA |
NPI | 1053623983 |
---|---|
Provider Name | Eric G Powell |
First Address | Seattle, WA 98104-1172 |
Second Address | Edmonds, WA 98026-8006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2010 |
Last Update Date | 08/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2030116 | (05) | WA |