Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | A79569 | CA |
NPI | 1407948052 |
---|---|
Provider Name | Lance Erik Westerlund |
First Address | Fortson, GA 31808-0370 |
Second Address | Columbus, GA 31909-3540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 20/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
105600 | (05) | AL |
388406095 | (05) | GA |