Doctor Name: | DR. KENNETH J O'BARA |
NPI Number: | 1144361304 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | MD00018701 |
Business Practice Address: | 6720 Fort Dent Way Suite 110 Tukwila, WA - 981888508 |
Business Phone Number: | 2062423651 |
Business Fax Number: | 2064337946 |
Mailing Address: | 6720 Fort Dent Way, Suite 110 TUKWILA |
State: | WA |
Postal Code: | 981888508 |
Phone Number: | 2062423651 |
Fax Number: | 2064337946 |
NPI Enumeration Date: | 02/09/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | MD00018701 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |