Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | DE00005663 | WA |
N | 204E00000X | Oral & Maxillofacial Surgeon | MD00024468 | WA |
NPI | 1295943595 |
---|---|
Provider Name | Thomas Joachim Laney |
First Address | Moses Lake, WA 98837-2410 |
Second Address | Moses Lake, WA 98837-2410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1035674 | (05) | WA |
141393 | DLI (01) | WA |
5005343 | (05) | WA |
TO2001 | (02) | WA |