Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | MD00014756 | WA |
NPI | 1023063369 |
---|---|
Provider Name | John D Allderdice |
First Address | Langley, WA 98260 |
Second Address | Monroe, WA 98272-1108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1092303 | (05) | WA |
D33863 | (02) | WA |