Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | PS00000061 | WA |
NPI | 1053631085 |
---|---|
Provider Name | Mr. Milo S Collier JR. |
First Address | Longview, WA 98632-7568 |
Second Address | Longview, WA 98632-4024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2010 |
Last Update Date | 01/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1057407 | (05) | WA |