Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 0102206538 | VA |
NPI | 1144719469 |
---|---|
Provider Name | Brian Lauer |
First Address | Wytheville, VA 24382-2236 |
Second Address | Wytheville, VA 24382-2236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2018 |
Last Update Date | 11/08/2021 |