Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD00034802 | WA |
N | 207PE0004X | Emergency Medical Services | MD00034802 | WA |
NPI | 1124084629 |
---|---|
Provider Name | Tracey B. Shirk |
First Address | Seattle, WA 98122-3699 |
Second Address | Seattle, WA 98122-4379 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2006 |
Last Update Date | 29/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8373219 | (05) | WA |
F07922 | (02) | WA |