Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | OP00001216 | WA |
NPI | 1023044880 |
---|---|
Provider Name | Steven Chas Brack |
First Address | Seattle, WA 98104 |
Second Address | Puyallup, WA 98374-2106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 18/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E17486 | (02) |