Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DE00009701 | WA |
NPI | 1689614588 |
---|---|
Provider Name | Dr. Robert James Achterberg |
First Address | Spokane, WA 99220-3405 |
Second Address | Spokane, WA 99216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 08/07/2007 |