Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD60153580 | WA |
N | 207NS0135X | Procedural Dermatology | MD60153580 | WA |
NPI | 1023144094 |
---|---|
Provider Name | Samir P. Master |
First Address | Mercer Island, WA 98040-0958 |
Second Address | Bellevue, WA 98004-3801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 30/12/2020 |