Dr. Glenn J. Kietzer
General Practice Physician
15005 Pacific Ave Spanaway General Medical
Tacoma
, Washington 98444
Dr. Glenn J. Kietzer
General Practice Physician
15005 Pacific Ave Spanaway General Medical
Tacoma
, Washington 98444
(253) 537-6425
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About
Features
Specialties
- General Practice Physician
Languages spoken
- English
Location
First Address
- Dr. Glenn J. Kietzer
- 15005 Pacific Ave Spanaway General Medical
- Tacoma, WA
- Zip : 98444
- Fax : (253) 537-6425
- Phone : (253) 537-3724
Second Address
- Dr. Glenn J. Kietzer
- 15005 Pacific Ave Spanaway General Medical
- Tacoma, WA
- Zip : 98444
- Fax : (253) 537-6425
- Phone : (253) 537-3724
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 208D00000X | General Practice Physician | MD00009584 | WA |
National Provider Identifier
| NPI | 1003847179 |
|---|---|
| Provider Name | Dr. Glenn J. Kietzer |
| First Address | Tacoma, WA 98444 |
| Second Address | Tacoma, WA 98444 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 06/07/2006 |
| Last Update Date | 07/05/2014 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 1195601 | (05) | WA |
| A04892 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.