Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD60773007 | WA |
Y | 207XS0106X | Orthopaedic Hand Surgeon | MD60773007 | WA |
NPI | 1134549272 |
---|---|
Provider Name | Mary Kathryn Thayer |
First Address | Issaquah, WA 98029-5436 |
Second Address | Bellevue, WA 98004-3812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2014 |
Last Update Date | 17/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2037339 | (05) | WA |