| Name | Value |
|---|---|
| PROVIDER TYPE | Allopathic & Osteopathic Physicians |
| CLASSIFICATION | Otolaryngology |
| DEFINITION | An otolaryngologist who specializes in the diagnosis and surgical treatment of head and neck conditions. |
| AREA OF SPECIALIZATION | Otolaryngology/Facial Plastic Surgery |
| STATUS | Active |
| VA CODE | V182203 |
| X12 CODE | 207YX0905X |
| SPECIALTY CODE | 04 |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5251499 |
| EFFECTIVE DATE/TIME |
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