Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 25MA075145 | NJ |
Y | 207KA0200X | Allergist | MD2016-0029 | NM |
NPI | 1619922622 |
---|---|
Provider Name | Dr. Richard A. Wachs |
First Address | Franklin, TN 37067-6670 |
Second Address | Albuquerque, NM 87109-4495 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 02/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
L13572 | (02) | NJ |