Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | BC61190205 | WA |
N | 207RP1001X | Pulmonary Disease | BC61190205 | WA |
NPI | 1053685107 |
---|---|
Provider Name | Thiago Antonio Jabuonski |
First Address | Everett, WA 98208-6526 |
Second Address | Everett, WA 98208-6526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2012 |
Last Update Date | 26/08/2021 |