Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 0101272617 | VA |
NPI | 1003348715 |
---|---|
Provider Name | David Ikeda |
First Address | Mechanicsville, VA 23116-1844 |
Second Address | Mechanicsville, VA 23116-1844 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2017 |
Last Update Date | 11/08/2021 |