Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DE00007404 | WA |
NPI | 1033131909 |
---|---|
Provider Name | Dr. Remigius Joseph Eussen |
First Address | Vancouver, WA 98686-6410 |
Second Address | Vancouver, WA 98686-6410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5034830 | (05) | WA |