Physicians (M.D. and D.O.) (90) PERSON CLASS (8932.1)
Name
Value
PROVIDER TYPE
Physicians (M.D. and D.O.)
CLASSIFICATION
Physician/Osteopath
AREA OF SPECIALIZATION
Pediatric Pathology
STATUS
Inactive
DATE INACTIVATED
2005-11-15 00:00:00
VA CODE
V113714
INDIVIDUAL/NON
INDIVIDUAL
MASTER ENTRY FOR VUID
YES
VUID
5253827
EFFECTIVE DATE/TIME
2018-04-02 15:34:54
STATUS: INACTIVE
