Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | MD00033439 | WA |
NPI | 1316055288 |
---|---|
Provider Name | Fielding Bruder Stapleton |
First Address | Seattle, WA 98105 |
Second Address | Seattle, WA 98105-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4361 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
8188815 | (05) | WA |
A91713 | (02) |