Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | MD00037743 | WA |
NPI | 1174676985 |
---|---|
Provider Name | Paul Gast |
First Address | Seattle, WA 98124-1584 |
Second Address | Seattle, WA 98112-5219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 19/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8264681 | (05) | WA |
H30886 | (02) | WA |