Physicians (M.D. and D.O.) (708) PERSON CLASS (8932.1)
Name
Value
PROVIDER TYPE
Physicians (M.D. and D.O.)
CLASSIFICATION
Physician/Osteopath
AREA OF SPECIALIZATION
Internal Medicine: Peripheral Vascular Disease
STATUS
Inactive
DATE INACTIVATED
2005-11-15 00:00:00
VA CODE
V111520
INDIVIDUAL/NON
INDIVIDUAL
MASTER ENTRY FOR VUID
YES
VUID
5253668
EFFECTIVE DATE/TIME
2018-04-02 15:35:22
STATUS: INACTIVE
