Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | MD00034001 | WA |
N | 2084N0600X | Clinical Neurophysiologist | MD00034001 | WA |
NPI | 1003997362 |
---|---|
Provider Name | Marcio A Sotero De Menezes |
First Address | Salt Lake City, UT 84125-0608 |
Second Address | Seattle, WA 98122-5312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 13/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003997362 | (05) | WA |
4821 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
8197725 | (05) | WA |
G11346 | (02) |