Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD00038097 | WA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD00038097 | WA |
NPI | 1215981774 |
---|---|
Provider Name | Tristan M. Mcgovern |
First Address | Port Angeles, WA 98362-3512 |
Second Address | Port Angeles, WA 98362-3512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 20/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200040914 | RAILROAD MEDICARE (01) | |
8250219 | (05) | WA |
F45330 | (02) | WA |