Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | AP61076820 | WA |
NPI | 1013535616 |
---|---|
Provider Name | Caleb Earl Kiser |
First Address | Lake Stevens, WA 98258-3108 |
Second Address | New Rochelle, NY 10801-5253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2020 |
Last Update Date | 09/07/2020 |