Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD00021107 | WA |
NPI | 1154471068 |
---|---|
Provider Name | Timothy J. Baltz |
First Address | Seattle, WA 98124-1581 |
Second Address | Seattle, WA 98112-5260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 14/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
232505 | LNI (01) | WA |
8114753 | (05) | WA |
E99493 | (02) | WA |