Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | CO004897 | WA |
Y | 222Z00000X | Podiatrist | CO004897 | WA |
N | 225000000X | Orthotic Fitter | CO004897 | WA |
NPI | 1669613360 |
---|---|
Provider Name | Ben George |
First Address | Tacoma, WA 98405-1806 |
Second Address | Tacoma, WA 98405-1806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2009 |
Last Update Date | 10/01/2012 |