Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | A152887 | CA |
NPI | 1013370717 |
---|---|
Provider Name | Jacob Russell Caylor |
First Address | Spokane, WA 99201-0418 |
Second Address | Spokane, WA 99201-0418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2016 |
Last Update Date | 23/06/2021 |