Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 025209-MD0001192 | WA |
NPI | 1063581775 |
---|---|
Provider Name | Terance R Kordash |
First Address | Spokane, WA 99223 |
Second Address | Spokane, WA 99223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1815505 | (05) | WA |
A07744 | (02) |