Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | PS60034066 | WA |
NPI | 1033611751 |
---|---|
Provider Name | Jeffrey A. Rodgers |
First Address | Seattle, WA 98108-1532 |
Second Address | Seattle, WA 98108-1532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2018 |
Last Update Date | 08/03/2018 |