Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | DR60949163 | WA |
NPI | 1477013233 |
---|---|
Provider Name | Raphael Huntley |
First Address | Saint Louis Park, MN 55416-1956 |
Second Address | Seattle, WA 98104-2420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2019 |
Last Update Date | 07/07/2019 |