Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD00045146 | WA |
Y | 207XS0106X | Orthopaedic Hand Surgeon | MD00045146 | WA |
NPI | 1316990088 |
---|---|
Provider Name | Anthony J Lauder |
First Address | Longview, WA 98632-2465 |
Second Address | Longview, WA 98632-2465 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 16/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1316990088 | NPI (01) | |
BL6956241 | DEA (01) | WA |
FL2249933 | DEA (01) | OR |