Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | D4952 | OR |
Y | 204E00000X | Oral & Maxillofacial Surgeon | DE00004943 | WA |
NPI | 1487786844 |
---|---|
Provider Name | Dr. Walter Douglas Klein |
First Address | Richland, WA 99352 |
Second Address | Richland, WA 99352 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 14/10/2010 |