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 | 2085R0202X | Radiology | Diagnostic Radiology | MD00039001 | 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 | 0230290 | OTHER | WASHINGTON | LABOR AND INDUSTRIES-UAOM |
| 2 | 0243532 | OTHER | WASHINGTON | LABOR AND INDUSTRIES-CAROL MILGARD BREAST CENTER |
| 3 | G8882927 | OTHER | WASHINGTON | PTAN-MIO1 |
| 4 | G8927632 | OTHER | WASHINGTON | PTAN-UAOM |
| 5 | 0249535 | OTHER | WASHINGTON | LABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST |
| 6 | 8871251 | OTHER | WASHINGTON | PTAN-TRA KING CO |
| 7 | 8946791 | OTHER | WASHINGTON | LABOR AND INDUSTRIES CRIME VICTIMS-TRA |
| 8 | 8951838 | OTHER | WASHINGTON | LABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST |
| 9 | P00689880 | OTHER | WASHINGTON | RR MEDICARE-CAROL MILGARD BREAST CENTER |
| 10 | 0230293 | OTHER | WASHINGTON | LABOR AND INDUSTRIES-TRA |
| 11 | 8946794 | OTHER | WASHINGTON | LABOR AND INDUSTRIES CRIME VICTIMS-UNION AVENUE OPEN MRI |
| 12 | G8878589 | OTHER | WASHINGTON | PTAN-CMBC |
| 13 | 8871252 | OTHER | WASHINGTON | PTAN-TRA PIERCE CO |
| 14 | 8949628 | OTHER | WASHINGTON | LABOR AND INDUSTRIES CRIME VICTIMS-CAROL MILGARD BREAST CENTER |
