| Name | Value |
|---|---|
| PROVIDER TYPE | Allopathic & Osteopathic Physicians |
| CLASSIFICATION | General Practice |
| DEFINITION | A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. |
| STATUS | Active |
| VA CODE | V180800 |
| X12 CODE | 208D00000X |
| SPECIALTY CODE | 01 |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5251430 |
| EFFECTIVE DATE/TIME |
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