Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | MD 00047502 | WA |
NPI | 1245202175 |
---|---|
Provider Name | Joseph Shvidler |
First Address | Gig Harbor, WA 98335-1700 |
Second Address | Gig Harbor, WA 98335-1700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 07/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0241810 | STATE L&I (01) | WA |
0267023 | STATE L&I (01) | WA |