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MR. IVAN PE LAW

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
176 1ST AVE N, ILWACO, WA 98624-9137
(360) 642-3747
(360) 642-3361
Mailing address
PO BOX N, ILWACO, WA 98624-0319
(360) 642-3747
(360) 642-3361

Taxonomy

Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
MD00031977
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
041160
OR
05
1233709
WA
Enumeration date
12/04/2007
Last updated
06/22/2022
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