Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | OP61152499 | WA |
N | 207P00000X | Emergency Physician | OT16180 | PA |
N | 207R00000X | Internist | OT16180 | PA |
N | 111NI0900X | Internist | OT16180 | PA |
Y | 207RC0200X | Critical Care Medicine | OP61152499 | WA |
NPI | 1083021448 |
---|---|
Provider Name | Sean Thrush |
First Address | Silverdale, WA 98383-7663 |
Second Address | Silverdale, WA 98383-7663 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2014 |
Last Update Date | 24/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2182662 | (05) | WA |