Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 9238 | WA |
NPI | 1467447433 |
---|---|
Provider Name | Dr. Bryan W Mclelland |
First Address | Spokane Valley, WA 99037-8535 |
Second Address | Spokane Valley, WA 99037-8535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5040738 | (05) | WA |
U82560 | (02) |