Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 19635 | WA |
NPI | 1023072006 |
---|---|
Provider Name | Kenneth H Z Isaacs |
First Address | Walla Walla, WA 99362-2800 |
Second Address | Walla Walla, WA 99362-2800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 15/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A09381 | (02) | WA |