Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0201X | Pediatric Allergist | MD00019575 | WA |
Y | 2080P0214X | Pediatric Pulmonologist | MD00019575 | WA |
NPI | 1619061389 |
---|---|
Provider Name | Michael M. Mccarthy |
First Address | Liberty Lake, WA 99019-0421 |
Second Address | Spokane, WA 99204-2302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 17/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1839109 | (05) | WA |
B18124 | (02) | WA |