Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 2085B0100X | Radiology | Body Imaging | 00037000 | WASHINGTON | No |
| 2 | 2085R0202X | Radiology | Diagnostic Radiology | MD00037000 | WASHINGTON | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 1940YO | OTHER | WASHINGTON | REGENCE BLUE SHIELD ADVANCED OPEN IMAGING |
| 2 | 8951825 | OTHER | WASHINGTON | LABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST |
| 3 | AB32476 | MEDICARE ID-TYPE UNSPECIFIED | WASHINGTON | TACOMA RADIOLOGICAL ASSOC |
| 4 | AB32477 | MEDICARE ID-TYPE UNSPECIFIED | WASHINGTON | UNION AVENUE OPEN MRI |
| 5 | 158188 | OTHER | WASHINGTON | LABOR AND INDUSTRIES/WC TRA |
| 6 | 158190 | OTHER | WASHINGTON | LABOR AND INDUSTRIES/WC UNION AVENUE OPEN |
| 7 | 0249559 | OTHER | WASHINGTON | LABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST |
| 8 | 170311 | OTHER | WASHINGTON | LABOR AND INDUSTRIES/WC ADVANCED OPEN IMAGING |
| 9 | H66831 | MEDICARE UPIN | WASHINGTON | |
| 10 | AB36535 | OTHER | WASHINGTON | MEDICARE PIN TRA KING COUNTY |
| 11 | 3231YO | OTHER | WASHINGTON | REGENCE BLUE SHIELD TRA |
| 12 | AB37885 | OTHER | WASHINGTON | MEDICARE PIN ADVANCED OPEN IMAGING |
| 13 | G8881872 | OTHER | WASHINGTON | PTAN-MIO1 |
| 14 | 300128232 | OTHER | WASHINGTON | RR MEDICARE TRA |
| 15 | 7252YO | OTHER | WASHINGTON | REGENCE BLUE SHIELD UNION AVENUE OPEN |
| 16 | 8296378 | MEDICAID | WASHINGTON | |
