Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | MD00036504 | WA |
N | 2080P0208X | Pediatric Infectious Diseases | MD00036504 | WA |
NPI | 1639221088 |
---|---|
Provider Name | Marvin S. Krober |
First Address | Seattle, WA 98124-1584 |
Second Address | Seattle, WA 98112-5211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 27/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8233199 | (05) | WA |
G17546 | (02) | WA |