| Name | Value |
|---|---|
| PROVIDER TYPE | Allopathic & Osteopathic Physicians |
| CLASSIFICATION | Otolaryngology |
| DEFINITION | An otolaryngologist who specializes in facial plastic surgery. |
| AREA OF SPECIALIZATION | Facial Plastic Surgery |
| STATUS | Active |
| VA CODE | V182201 |
| X12 CODE | 207YS0123X |
| SPECIALTY CODE | 04 |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5251487 |
| EFFECTIVE DATE/TIME |
|