Name | Value |
---|---|
PROVIDER TYPE | Physicians (M.D. and D.O.) |
CLASSIFICATION | Physician/Osteopath |
STATUS | Inactive |
DATE INACTIVATED | 2005-11-15 00:00:00 |
VA CODE | V110000 |
INDIVIDUAL/NON | INDIVIDUAL |
MASTER ENTRY FOR VUID | YES |
VUID | 5253521 |
EFFECTIVE DATE/TIME |
|