Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | MD00031422 | WA |
NPI | 1033310222 |
---|---|
Provider Name | Michael J Boeckh |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98109-4433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8152662 | (05) | WA |
F73709 | (02) | WA |