Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 036-128815 | IL |
N | 207YS0123X | Facial Plastic Surgeon | 036-128815 | IL |
N | 2082S0105X | Plastic Hand Surgeon | 036128815 | IL |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 036-128815 | IL |
NPI | 1265548945 |
---|---|
Provider Name | Dr. Ronald V. Washak |
First Address | Rockford, IL 61103-3619 |
Second Address | Rockford, IL 61103-3619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 29/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1265548945 | (05) | WI |
E96162 | (02) |