Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | OP00001228 | WA |
NPI | 1609968304 |
---|---|
Provider Name | William E. Dickinson |
First Address | Everett, WA 98201-1409 |
Second Address | Everett, WA 98201-4147 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 29/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8144438 | (05) | WA |
E74825 | (02) | WA |