Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 3443 | AK |
NPI | 1053396838 |
---|---|
Provider Name | Pedro Jimenez Valdes |
First Address | Seattle, WA 98124-5864 |
Second Address | Anchorage, AK 99508-2953 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 22/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000WFBKK | MCARE ACS GRP (01) | |
A84238 | (02) | |
DC1725 | RAILROAD MEDICARE (01) | |
MD1611 | (05) | AK |