Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | DE00004338 | WA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | MD00017630 | WA |
NPI | 1245330059 |
---|---|
Provider Name | Gary R Feldman |
First Address | Seattle, WA 98104-3588 |
Second Address | Seattle, WA 98104-3588 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 09/08/2017 |