Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD00026725 | WA |
NPI | 1003852872 |
---|---|
Provider Name | Fredric T Lo |
First Address | Federal Way, WA 98003-6328 |
Second Address | Federal Way, WA 98003-6761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 28/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0171299 | LIWA (01) | WA |
8120941 | (05) | WA |
C34386 | (02) | WA |
LO1176 | BSWA (01) | WA |
LO6879 | BSWA (01) | WA |