Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH00000764 | WA |
NPI | 1447376173 |
---|---|
Provider Name | Dr. Leamon C. Sandifer |
First Address | Lacey, WA 98509-5310 |
Second Address | Olympia, WA 98501-2115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CH00000764 | STATE OF WA (01) | WA |