Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO00000207 | WA |
Y | 222Z00000X | Podiatrist | PO00000207 | WA |
N | 111NR0200X | Radiology | PO00000207 | WA |
N | 213ER0200X | Radiology | PO00000207 | WA |
N | 213ES0103X | Foot & Ankle Surgery | PO00000207 | WA |
N | 213ES0131X | Foot Surgery | PO00000207 | WA |
NPI | 1518908573 |
---|---|
Provider Name | Dr. Jac R Tiechner |
First Address | Wenatchee, WA 98801-2025 |
Second Address | Wenatchee, WA 98801-2025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 01/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0035677 | WA STATE LABOR AND INDUSTRY GROUP # (01) | WA |
1013614 | (05) | WA |
15520000 | WA STATE LABOR AND INDUSTRY (01) | WA |
480661080 | PALMETTO GBA RAILROAD MEDICARE PART B (01) | WA |
T86897 | (02) |