Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD00023731 | WA |
N | 207PE0004X | Emergency Medical Services | MD00023731 | WA |
NPI | 1043249360 |
---|---|
Provider Name | Patrick O'neill |
First Address | Chehalis, WA 98532-9112 |
Second Address | Centralia, WA 98531-9027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 19/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1015213 | (05) | WA |
C87611 | (02) | WA |