Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | MD00012160 | WA |
NPI | 1013104165 |
---|---|
Provider Name | John S Arthur |
First Address | Bremerton, WA 98310-3305 |
Second Address | Bremerton, WA 98310-3305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2007 |
Last Update Date | 15/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1254705 | (05) | WA |
A06886 | (02) | WA |