Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | MD00015885 | WA |
NPI | 1023081163 |
---|---|
Provider Name | Lanie Belic |
First Address | Tacoma, WA 98401-1241 |
Second Address | Tacoma, WA 98405-2318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 04/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1455302 | (05) | WA |
A06319 | (02) | WA |