Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD00011964 | WA |
NPI | 1184648586 |
---|---|
Provider Name | W. Gary Becker |
First Address | Tacoma, WA 98405-1333 |
Second Address | Tacoma, WA 98405-1333 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1387505 | (05) | WA |
A08319 | (02) | WA |