Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | PT00010238 | WA |
N | 2081P2900X | Pain Medicine | PT00010238 | WA |
N | 2081S0010X | Sports Medicine | PT00010238 | WA |
N | 213ES0000X | Sports Medicine | PT00010238 | WA |
NPI | 1275725038 |
---|---|
Provider Name | Jonathan L Losee |
First Address | Centralia, WA 98531-9027 |
Second Address | Centralia, WA 98531-9027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2007 |
Last Update Date | 15/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8463580 | (05) | WA |