Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | 20891 | WV |
NPI | 1013056738 |
---|---|
Provider Name | Ramon S Lansang JR. |
First Address | Chas, WV 25301 |
Second Address | Charleston, WV 25301-1326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0030430000 | (05) | WV |
BL7762049 | DEA (01) | |
H71680 | (02) |