Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD00047541 | WA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD00047541 | WA |
NPI | 1053450627 |
---|---|
Provider Name | Reza Tabibi |
First Address | Seattle, WA 98124-1036 |
Second Address | Kirkland, WA 98034-4317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 07/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0220450 | LABOR & IND. (01) | WA |
243067 | (05) | OR |
8480790 | (05) | WA |
8944545 | CRIME VICTIMS (01) | WA |
P00410143 | RAILROAD MEDICARE (01) |