Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | MD00009270 | WA |
N | 156FX1100X | Ophthalmic | MD07542 | OR |
NPI | 1518011550 |
---|---|
Provider Name | Dr. Robert Charles Tudor |
First Address | Kennewick, WA 99336-7757 |
Second Address | Kennewick, WA 99336-7757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A82357 | (02) |