Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 0100000073 | WA |
N | 222Z00000X | Podiatrist | 0100000073 | WA |
Y | 224P00000X | Prosthetist | PS00000074 | WA |
NPI | 1326088378 |
---|---|
Provider Name | Mr. Raland A. John |
First Address | Spokane, WA 99208 |
Second Address | Spokane, WA 99208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 13/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8418691 | PIN NUMBER MEDICAID (01) | WA |
9011495 | (05) | WA |
911172804 | (02) | |
CP001296 | ABC NBR 033831 (01) |