Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | A130849 | CA |
Y | 207N00000X | Dermatologist | MD60726633 | WA |
N | 207ND0101X | MOHS-Micrographic Surgeon | MD457554 | PA |
N | 207ND0101X | MOHS-Micrographic Surgeon | MD60726633 | WA |
NPI | 1306106547 |
---|---|
Provider Name | Dr. David Panther |
First Address | Walla Walla, WA 99362 |
Second Address | Walla Walla, WA 99362-4445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2012 |
Last Update Date | 24/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2078121 | (05) | WA |