Individual
BEI HE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4111 194TH ST SW, LYNNWOOD, WA 98036-4604
(142) 583-5520
Mailing address
1125 N COLLEGE AVE, FAYETTEVILLE, AR 72703-1908
(479) 713-8000
(479) 444-7820
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
34099
OK
207Q00000X
Family Medicine Physician
Primary
C205687
CA
207Q00000X
Family Medicine Physician
E-10683
AR
207Q00000X
Family Medicine Physician
MD.MD.61545852
WA
Other
Enumeration date
03/25/2015
Last updated
03/16/2026
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