Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 0101230281 | VA |
NPI | 1003843541 |
---|---|
Provider Name | Swen Ericson Laser |
First Address | Charlotte, NC 28289-0580 |
Second Address | Fishersville, VA 22939 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 24/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005707951 | (05) | VA |
F54567 | (02) | VA |