Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 31723 | WA |
NPI | 1013923960 |
---|---|
Provider Name | Dr. John Heusner |
First Address | Spokane, WA 99204-2483 |
Second Address | Spokane, WA 99204-2483 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 25/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8170896 | (05) | WA |
G02627 | (02) |