Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 995 | IA |
Y | 222Z00000X | Podiatrist | 995 | IA |
N | 224P00000X | Prosthetist | 995 | IA |
NPI | 1164815981 |
---|---|
Provider Name | Mr. Bruce Alan Strelow |
First Address | Spokane, WA 99204-2620 |
Second Address | Spokane, WA 99204-2620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2015 |
Last Update Date | 18/03/2015 |