Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | MD60847731 | WA |
N | 207R00000X | Internist | PG158620 | OR |
N | 111NI0900X | Internist | PG158620 | OR |
NPI | 1386905917 |
---|---|
Provider Name | Kelly Anne Griffith-Bauer |
First Address | Seattle, WA 98101-1720 |
Second Address | Seattle, WA 98101-1720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2012 |
Last Update Date | 28/06/2018 |