Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 60349185 | WA |
NPI | 1023454204 |
---|---|
Provider Name | Maryse Bouchard |
First Address | Seattle, WA 98105-0371 |
Second Address | Seattle, WA 98105-0371 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2013 |
Last Update Date | 06/07/2014 |