Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | MD00043860 | WA |
N | 208200000X | Surgeon | MD00043860 | WA |
N | 208600000X | Surgeon | MD00043860 | WA |
NPI | 1376621730 |
---|---|
Provider Name | Jorge Dionisio Reyes |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98195-6165 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 13/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1376621730 | (05) | WA |
E28486 | (02) |