Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD00014612 | WA |
Y | 2080P0207X | Pediatric Hematology-Oncologist | MD00014612 | WA |
NPI | 1124109483 |
---|---|
Provider Name | Thomas W Pendergrass |
First Address | Seattle, WA 98145-5005 |
Second Address | Seattle, WA 98105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 18/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0826 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
8362105 | (05) | WA |
A06311 | (02) |