Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 9059 | WA |
NPI | 1083798649 |
---|---|
Provider Name | Dr. Lindsey R Douglas III |
First Address | Yakima, WA 98908-3347 |
Second Address | Yakima, WA 98908-3347 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5036942 | (05) | WA |
AB23313 | (02) |