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Individual

LEO EUGENE OBERMILLER JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Taxonomy

Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
025209
WA
207RN0300X
Nephrology Physician
M5092
ID
207RN0300X
Nephrology Physician
MD00019462
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010000219
REGENCE BLUE SHIELD OF ID
05
805903500
ID
05
8111304
WA
Enumeration date
09/27/2006
Last updated
06/23/2021
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