Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 0401005072 | VA |
Y | 213EG0000X | General Practice | 0401005072 | VA |
NPI | 1003823832 |
---|---|
Provider Name | Mckinley Lenard Price |
First Address | Newport News, VA 23606-1980 |
Second Address | Newport News, VA 23606-1980 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
321044 | ANTHEM (01) | |
9178617 | (05) | VA |