Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD60069013 | WA |
N | 111NI0900X | Internist | MD60069013 | WA |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | MD60069013 | WA |
N | 207RC0000X | Internist - Cardiovascular Disease | MD60069013 | WA |
NPI | 1194834127 |
---|---|
Provider Name | John L Mignone |
First Address | Salt Lake City, UT 84125-0608 |
Second Address | Seattle, WA 98122-5649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 07/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1194834127 | (05) | WA |