Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 148774 | CA |
N | 207N00000X | Dermatologist | 79073 | MT |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 60840220 | WA |
NPI | 1275973398 |
---|---|
Provider Name | Dr. Lark Greenwald Guss |
First Address | Spokane, WA 99202-1332 |
Second Address | Spokane, WA 99202-1332 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2013 |
Last Update Date | 08/12/2021 |