Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD00026838 | WA |
N | 208000000X | Pediatrician | MD00026838 | WA |
NPI | 1194882902 |
---|---|
Provider Name | Wayne A. Sladek |
First Address | Seattle, WA 98124-1584 |
Second Address | Tacoma, WA 98405-4265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 07/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8121485 | (05) | WA |
E57805 | (02) | WA |