Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | MD00031004 | WA |
NPI | 1275607913 |
---|---|
Provider Name | Thomas V. Brogan |
First Address | Seattle, WA 98105-1010 |
Second Address | Seattle, WA 98105-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8160624 | (05) | WA |
F59616 | (02) | WA |