Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO60436994 | WA |
NPI | 1043507973 |
---|---|
Provider Name | Dr. Brent James Thielges |
First Address | Pasco, WA 99301-8028 |
Second Address | Pasco, WA 99301-8028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2011 |
Last Update Date | 20/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2035708 | (05) | WA |