Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD00027435 | WA |
N | 208000000X | Pediatrician | MD00027435 | WA |
NPI | 1225071897 |
---|---|
Provider Name | Robert David Hylander |
First Address | Moses Lake, WA 98837-3800 |
Second Address | Moses Lake, WA 98837-3800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 15/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1076926 | (05) | WA |
BH2103606 | DEA NR (01) | WA |
C96533 | (02) | WA |
MD00027435 | STATE MEDICAL LICENSE NR (01) | WA |