| Name | Value |
|---|---|
| PROVIDER TYPE | Allopathic & Osteopathic Physicians |
| CLASSIFICATION | Family Medicine |
| DEFINITION | A family medicine physician with multidisciplinary training in the unique physical, psychological and social characteristics of adolescents and their health care problems and needs. |
| AREA OF SPECIALIZATION | Adolescent Medicine |
| STATUS | Active |
| VA CODE | V180702 |
| X12 CODE | 207QA0000X |
| SPECIALTY CODE | 08 |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5251601 |
| EFFECTIVE DATE/TIME |
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