Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | M-8366 | ID |
N | 207RC0000X | Internist - Cardiovascular Disease | MD00040353 | WA |
NPI | 1003820275 |
---|---|
Provider Name | Robert Alan Wales |
First Address | Liberty Lake, WA 99019-0331 |
Second Address | Lewiston, ID 83501-7301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 01/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060064955 | RRB (01) | WA |
806097900 | (05) | ID |
8283913 | (05) | WA |
G80517 | (02) |