Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 12820 | HI |
NPI | 1003891276 |
---|---|
Provider Name | Dr. Chad Bender |
First Address | Centralia, WA 98531-9073 |
Second Address | Centralia, WA 98531-9073 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2005 |
Last Update Date | 09/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD000 | (02) |