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 | 2085N0700X | Radiology | Neuroradiology | MD00026448 | WASHINGTON | No |
| 2 | 2085R0202X | Radiology | Diagnostic Radiology | MD00026448 | 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 | 170310 | OTHER | WASHINGTON | LABOR AND INDUSTRIES ADVANCED OPEN IMAGING |
| 2 | 8951832 | OTHER | WASHINGTON | LABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST |
| 3 | AB37889 | OTHER | WASHINGTON | MEDICARE PIN ADVANCED OPEN IMAGING |
| 4 | G8881784 | OTHER | WASHINGTON | PTAN-MIO1 |
| 5 | 5552WE | MEDICARE PIN | WASHINGTON | |
| 6 | WE7252 | OTHER | WASHINGTON | REGENCE BLUE SHIELD UNION AVENUE OPEN |
| 7 | 1940WE | OTHER | WASHINGTON | REGENCE BLUE SHIELD ADVANCED OPEN IMAGING |
| 8 | G8886633 | MEDICARE PIN | WASHINGTON | |
| 9 | 0249566 | OTHER | WASHINGTON | LABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST |
| 10 | 65992 | OTHER | WASHINGTON | LABOR AND INDUSTRIES TRA |
| 11 | 119255 | OTHER | WASHINGTON | LABOR AND INDUSTRIES UNION AVENUE OPEN |
| 12 | 8945540 | OTHER | WASHINGTON | LABOR AND INDUSTRIES CRIME VICTIMS-UNION AVENUE OPEN MRI |
| 13 | AB36532 | OTHER | WASHINGTON | MEDICARE PIN TRA KING COUNTY |
| 14 | E72296 | MEDICARE UPIN | WASHINGTON | |
| 15 | 8202574 | MEDICARE PIN | WASHINGTON | |
| 16 | WE9613 | OTHER | WASHINGTON | REGENCE BLUE SHIELD TRA |
| 17 | 300021800 | OTHER | WASHINGTON | RR MEDICARE TRA |
| 18 | G001055621 | OTHER | WASHINGTON | PTAN-TRA PIERCE CO |
| 19 | 8202574 | MEDICAID | WASHINGTON | |
| 20 | 8944810 | OTHER | WASHINGTON | LABOR AND INDUSTRIES CRIME VICTIMS-TRA |
