Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MA60246912 | WA |
NPI | 1457628232 |
---|---|
Provider Name | Cyrus Dale Haskett JR. |
First Address | Astoria, OR 97103-5606 |
Second Address | Ilwaco, WA 98624-9089 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2011 |
Last Update Date | 22/11/2011 |