Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD00032782 | WA |
N | 207PE0004X | Emergency Medical Services | MD00032782 | WA |
NPI | 1053378158 |
---|---|
Provider Name | Richard Mcmonigal |
First Address | Tacoma, WA 98422-2293 |
Second Address | Auburn, WA 98001-4939 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 29/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8017436 | (05) | WA |
G13163 | (02) | WA |