Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD22926 | OR |
NPI | 1013923572 |
---|---|
Provider Name | Trenton John Spolar |
First Address | Yacolt, WA 98675 |
Second Address | The Dalles, OR 97058 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A08087 | (02) |