Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | MD00044240 | WA |
NPI | 1124139738 |
---|---|
Provider Name | Roland B Walter |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98109-1023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 24/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0232140 | L&I (01) | WA |
1124139738 | (05) | WA |