Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | MD00015423 | WA |
NPI | 1033299037 |
---|---|
Provider Name | W T Longstreth JR. |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 12/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0231447 | L&I (01) | WA |
1033299037 | (05) | WA |
761 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
A05050 | (02) |