Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 2004014354 | MO |
NPI | 1316062136 |
---|---|
Provider Name | George Stephan Raj |
First Address | Bellingham, WA 98225-2959 |
Second Address | Bellingham, WA 98225-2959 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 07/10/2011 |