Physicians (M.D. and D.O.) (150) PERSON CLASS (8932.1)
Name
Value
PROVIDER TYPE
Physicians (M.D. and D.O.)
CLASSIFICATION
Physician/Osteopath
AREA OF SPECIALIZATION
Surgery, Head & Neck
STATUS
Inactive
DATE INACTIVATED
2005-11-15 00:00:00
VA CODE
V116200
INDIVIDUAL/NON
INDIVIDUAL
MASTER ENTRY FOR VUID
YES
VUID
5254061
EFFECTIVE DATE/TIME
2018-04-02 15:35:35
STATUS: INACTIVE
