Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 8497 | ND |
Y | 207QA0505X | Family Doctor - Adult Medicine | OP00001786 | WA |
NPI | 1265560049 |
---|---|
Provider Name | George Brian Dueber |
First Address | Westport, WA 98595 |
Second Address | Westport, WA 98595 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2007 |
Last Update Date | 01/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
#8312522 | (05) | WA |
1461174 | (05) | ND |
H23404 | (02) | WA |