Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | LL17969 | OR |
Y | 2080P0207X | Pediatric Hematology-Oncologist | MD60536251 | WA |
NPI | 1043464373 |
---|---|
Provider Name | Dr. David Ross Goshorn |
First Address | Liberty Lake, WA 99019-0421 |
Second Address | Spokane, WA 99204-2307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2008 |
Last Update Date | 25/05/2021 |