Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 0002528 | WA |
NPI | 1366504185 |
---|---|
Provider Name | Dr. Eugene Carl Weber |
First Address | Yakima, WA 98902-3666 |
Second Address | Yakima, WA 98902-3666 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 12/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34843 | LABOR & INDUSTRIES (01) | WA |
WE7890 | REGENCE (01) | WA |