Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | MD00027334 | WA |
NPI | 1033294830 |
---|---|
Provider Name | Mary Lenora Disis |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98195-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 28/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0230984 | L&I (01) | WA |
1033294830 | (05) | WA |
9031 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
E18348 | (02) |