Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | OI00000271 | WA |
Y | 222Z00000X | Podiatrist | OI00000271 | WA |
NPI | 1023253036 |
---|---|
Provider Name | Mr. Gregory Bayard Nelson |
First Address | Seattle, WA 98108-1532 |
Second Address | Seattle, WA 98108-1532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2008 |
Last Update Date | 04/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
O 1509 | AMERICAN BOARD OF CERTIFICATION P&O (01) |