Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 0101234782 | VA |
NPI | 1548217326 |
---|---|
Provider Name | John David Lieser |
First Address | Fredericksburg, VA 22401-3511 |
Second Address | Fredericksburg, VA 22401-3511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 30/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I52192 | (02) | |
P00380301 | MEDICARE RAILROAD (01) | VA |