Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD00044985 | WA |
Y | 207QS0010X | Family Doctor - Sports Medicine | MD00044985 | WA |
NPI | 1225073398 |
---|---|
Provider Name | Justin D Rothmier |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98133-9463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 31/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1225073398 | (05) | WA |
I56373 | (02) | WA |