Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 47690 | CO |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OP60448689 | WA |
Y | 207Q00000X | Family Doctor | 47690 | CO |
N | 207Q00000X | Family Doctor | OP60448689 | WA |
NPI | 1053533851 |
---|---|
Provider Name | Dr. David M. Kanze |
First Address | Mount Vernon, WA 98274-4127 |
Second Address | Mount Vernon, WA 98274 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 01/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053533851 | (05) | WA |