Basic Information
| Provider Information | |||||||||
| NPI: | 1790759629 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PROW | ||||||||
| FirstName: | HAROLD | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19020 33RD AVE W STE 210 | ||||||||
| Address2: | |||||||||
| City: | LYNNWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980364748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4255631500 | ||||||||
| FaxNumber: | 4255631374 | ||||||||
| Practice Location | |||||||||
| Address1: | 19020 33RD AVE W STE 210 | ||||||||
| Address2: | |||||||||
| City: | LYNNWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4255631500 | ||||||||
| FaxNumber: | 4255631501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 05/15/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD00039626 | WA | N | Other Service Providers | Specialist | 2085N0700X | MD00039626 | WA | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | 109096 | AK | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | M-13472 | ID | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085R0202X | 109096 | AK | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | M-13472 | ID | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD00039626 | WA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 2111PR | 01 | WA | REGENCE | OTHER | 8929685 | 01 | WA | CRIME VICTIMS | OTHER | 8275554 | 05 | WA | MEDICAID | 147657 | 01 | WA | L&I | OTHER | 2604793 | 01 | AETNA | OTHER | 350385 | 01 | WA | L&I-SWEDISH RADIA | OTHER | 1019031 | 05 | WA | MEDICAID | 350383 | 01 | WA | L&I-RADIA REST OF WA | OTHER | 350384 | 01 | WA | L&I-RADIA KING COUNTY | OTHER | 350386 | 01 | WA | L&I-EVERGREEN RADIA | OTHER |