Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD00035810 | WA |
N | 207NS0135X | Procedural Dermatology | MD00035810 | WA |
NPI | 1316948904 |
---|---|
Provider Name | Mr. James H Petrin |
First Address | Woodinville, WA 98072-6928 |
Second Address | Woodinville, WA 98072-6928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 13/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
128869 | DEPT OF L&I (01) | WA |
53030 | DEPT OF L&I GROUP (01) | WA |
7095656 | (05) | WA |
7136443 | (05) | WA |
8228371 | (05) | WA |
G66465 | (02) | WA |