Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | MD00043129 | WA |
NPI | 1013904143 |
---|---|
Provider Name | Dr. Gregory A Connell |
First Address | Vancouver, WA 98668-5157 |
Second Address | Vancouver, WA 98664-3200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2005 |
Last Update Date | 02/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I02772 | (02) | WA |