Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | WA |
NPI | 1760542153 |
---|---|
Provider Name | Dr. Darrell K. Tew |
First Address | Yakima, WA 98902-4875 |
Second Address | Yakima, WA 98902-4875 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GAB37341 | (02) | WA |