Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD00024030 | WA |
NPI | 1023194883 |
---|---|
Provider Name | Ernest U Conrad III |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98105-4740 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7330 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
8105223 | (05) | WA |
B18147 | (02) |