Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | MD60253997 | WA |
N | 208000000X | Pediatrician | 4301090330 | MI |
NPI | 1639372857 |
---|---|
Provider Name | Sara Ahmed |
First Address | Tacoma, WA 98405-4234 |
Second Address | Tacoma, WA 98405-4234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 27/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MD60253997 | STATE LICENCE (01) | WA |