Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | MD00035801 | WA |
NPI | 1073609699 |
---|---|
Provider Name | Paul M Mystkowski |
First Address | Bellevue, WA 98004-3819 |
Second Address | Bellevue, WA 98004-3819 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 13/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8239667 | (05) | WA |
H45627 | (02) |