Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 91-308 | NM |
NPI | 1164607982 |
---|---|
Provider Name | Dr. Welman Austin Shrader JR. |
First Address | Santa Fe, NM 87505 |
Second Address | Santa Fe, NM 87501-2914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2007 |
Last Update Date | 31/12/2007 |