Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | OP60961030 | WA |
NPI | 1174817118 |
---|---|
Provider Name | Dr. Christopher Iwanoff |
First Address | Tacoma, WA 98431-1100 |
Second Address | Tacoma, WA 98431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2011 |
Last Update Date | 26/04/2020 |