Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | MD00023067 | WA |
NPI | 1669517124 |
---|---|
Provider Name | Gunnar E Holmquist |
First Address | Seattle, WA 98124-1584 |
Second Address | Spokane, WA 99201-3208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 19/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8000622 | (05) | WA |
F05201 | (02) | WA |