Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 27908 | WA |
NPI | 1053376350 |
---|---|
Provider Name | Jeffrey Bard Moo |
First Address | Shoreline, WA 98177-3723 |
Second Address | Seattle, WA 98122-5698 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 06/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1111038 | (05) | WA |
130982 | LABOR & INDUSTRIES NUMBER (01) | WA |
F36404 | (02) | WA |