Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | MD00043699 | WA |
NPI | 1013074558 |
---|---|
Provider Name | Mr. Trent Lane Tredway |
First Address | Seattle, WA 98101-3751 |
Second Address | Seattle, WA 98101-3751 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 27/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0232078 | L&I (01) | WA |
1013074558 | (05) | WA |
320940 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
I04429 | (02) |