Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD00043261 | WA |
Y | 208600000X | Surgeon | MD00043261 | WA |
N | 2086S0102X | Surgical Critical Care | MD00043261 | WA |
N | 2086S0127X | Trauma Surgeon | MD00043261 | WA |
NPI | 1265543144 |
---|---|
Provider Name | Erik Gentry Van Eaton |
First Address | Seattle, WA 98195-6410 |
Second Address | Seattle, WA 98195-6410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 30/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
219070 | (02) | WA |