Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | MD00022196 | WA |
NPI | 1083754154 |
---|---|
Provider Name | Thomas J. Yetman |
First Address | Seattle, WA 98144-2712 |
Second Address | Seattle, WA 98144-2712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E82782 | (02) |