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 | 2085R0204X | Radiology | Vascular & Interventional Radiology | 00023967 | WASHINGTON | No |
| 2 | 2085R0202X | Radiology | Diagnostic Radiology | MD00046304 | 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 | AB36529 | OTHER | WASHINGTON | MEDICARE PIN TRA KING COUNTY |
| 2 | 30022483 | OTHER | WASHINGTON | RR MEDICARE TRA |
| 3 | 7252TO | OTHER | WASHINGTON | REGENCE BLUE SHIELD UNION AVENUE OPEN |
| 4 | GAB36529 | MEDICARE PIN | WASHINGTON | |
| 5 | 40713 | OTHER | WASHINGTON | LABOR AND INDUSTRIES/WC TRA |
| 6 | 0260103 | OTHER | WASHINGTON | LABOR AND INDUSTRIES-UNION AVENUE OPEN MRI |
| 7 | 8945850 | OTHER | WASHINGTON | LABOR AND INDUSTRIES CRIME VICTIMS-TRA |
| 8 | 8946139 | OTHER | WASHINGTON | LABOR AND INDUSTRIES CRIME VICTIMS-UNION AVENUE OPEN MRI |
| 9 | A08950 | MEDICARE UPIN | WASHINGTON | |
| 10 | 0249555 | OTHER | WASHINGTON | LABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST |
| 11 | G8881791 | OTHER | WASHINGTON | PTAN-MIO1 |
| 12 | TO7580 | OTHER | WASHINGTON | REGENCE BLUE SHIELD TRA |
| 13 | 8951858 | OTHER | WASHINGTON | LABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST |
| 14 | 8125346 | MEDICAID | WASHINGTON | |
| 15 | G001055612 | MEDICARE PIN | WASHINGTON | |
