Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD00017040 | WA |
N | 111NI0900X | Internist | MD00017040 | WA |
Y | 207RA0201X | Internist - Allergy & Immunology | MD00017040 | WA |
NPI | 1639254436 |
---|---|
Provider Name | William R Henderson JR. |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98195-6166 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 03/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0231176 | L&I (01) | WA |
1639254436 | (05) | WA |
1850 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
A04703 | (02) |