Individual
AJAY KUMAR GOPAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
AMBULATORY CLINIC, 825 EASTLAKE AVENUE EAST, SEATTLE, WA 98109
(206) 288-1000
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 543-6420
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD00034592
WA
207RX0202X
Medical Oncology Physician
Primary
MD00034592
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0231159
L&I
WA
05
—
1194801902
—
WA
01
—
2000181
INTERNAL ID-MOTOR VEHICLE ID
—
Enumeration date
10/27/2006
Last updated
10/26/2011
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