| Name | Value |
|---|---|
| PROVIDER TYPE | Allopathic & Osteopathic Physicians |
| CLASSIFICATION | Internal Medicine |
| DEFINITION | An internal medicine physician who specializes in clinical and laboratory immunology disease management. |
| AREA OF SPECIALIZATION | Clinical & Laboratory Immunology |
| STATUS | Active |
| VA CODE | V181005 |
| X12 CODE | 207RI0001X |
| SPECIALTY CODE | 11 |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5251685 |
| EFFECTIVE DATE/TIME |
|