Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD00014938 | WA |
NPI | 1063597896 |
---|---|
Provider Name | Richard E Berger |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98195-6158 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 13/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0230743 | L&I (01) | WA |
0809 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
1063597896 | (05) | WA |
A04069 | (02) |