Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | OP60967755 | WA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | OP60967755 | WA |
NPI | 1538455977 |
---|---|
Provider Name | Dr. Paul R Lentz |
First Address | Corvallis, OR 97330-3737 |
Second Address | Puyallup, WA 98372-3715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2011 |
Last Update Date | 01/11/2019 |