Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 290502 | MA |
N | 208200000X | Surgeon | MD60939550 | WA |
N | 208600000X | Surgeon | MD60939550 | WA |
NPI | 1376962654 |
---|---|
Provider Name | James B. Hendele |
First Address | Burlington, MA 01805-5095 |
Second Address | Seattle, WA 98195-7232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2014 |
Last Update Date | 29/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1376962654 | (05) | WA |