Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | MD00041666 | WA |
N | 207ND0101X | MOHS-Micrographic Surgeon | MD00041666 | WA |
N | 207NS0135X | Procedural Dermatology | MD00041666 | WA |
NPI | 1548235450 |
---|---|
Provider Name | Joseph L Cvancara |
First Address | Spokane, WA 99217-9336 |
Second Address | Spokane Valley, WA 99212-2444 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8394447 | (05) | WA |
H75543 | (02) | WA |