Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | MD00043820 | WA |
NPI | 1023108917 |
---|---|
Provider Name | Robert L Mazor |
First Address | Seattle, WA 98105-3900 |
Second Address | Seattle, WA 98105-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
322830 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
8398497 | (05) | WA |
H88812 | (02) |