Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | CH00000853 | WA |
NPI | 1144371782 |
---|---|
Provider Name | Dr. Fred Rudolph Loertscher |
First Address | Aberdeen, WA 98520-4704 |
Second Address | Aberdeen, WA 98520-4704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13278 | DEPT OF LABOR AND INDUSTR (01) | WA |
LO0307 | REGENCE BLUESHIELD (01) | WA |
U21639 | (02) | WA |