Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | OP60262509 | WA |
NPI | 1902054760 |
---|---|
Provider Name | Dr. Jordan Justin Tjeerd Mulder |
First Address | Olympia, WA 98502-8654 |
Second Address | Olympia, WA 98502-8701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2008 |
Last Update Date | 16/12/2019 |