Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | MD60071474 | WA |
NPI | 1447454954 |
---|---|
Provider Name | David Shane Verschueren |
First Address | Vancouver, WA 98683-5297 |
Second Address | Vancouver, WA 98683-5297 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 22/07/2009 |