Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD00034623 | WA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MD00034623 | WA |
N | 2086S0122X | Plastic and Reconstructive Surgery | MD00034623 | WA |
NPI | 1467410613 |
---|---|
Provider Name | John D Burgoyne |
First Address | Seattle, WA 98104-1172 |
Second Address | Seattle, WA 98104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 28/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8206468 | (05) | WA |
BU5281 | REGENCE (01) | WA |
F22530 | (02) | WA |