Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | MD00029723 | WA |
NPI | 1033290390 |
---|---|
Provider Name | John H T Waldhausen |
First Address | Seattle, WA 98105-3900 |
Second Address | Seattle, WA 98105-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0962 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
8154189 | (05) | WA |
F75310 | (02) |