Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD00021891 | WA |
N | 207NP0225X | Pediatric Dermatologist | MD00021891 | WA |
N | 207NS0135X | Procedural Dermatology | MD00021891 | WA |
NPI | 1225131865 |
---|---|
Provider Name | Lauri M Tadlock |
First Address | Bellevue, WA 98007 |
Second Address | Bellevue, WA 98007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 28/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070007061 | RAILROAD MEDICARE (01) | WA |
1087154 | (05) | WA |
4120050 | AETNA (01) | |
7080237 | (05) | WA |
A06461 | (02) | |
CN9262 | RAILROAD MEDICARE (01) | WA |
TA0069 | REGENCE (01) |