Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 05834 | WA |
NPI | 1285705350 |
---|---|
Provider Name | Dr. Kenneth J Ritter |
First Address | Tacoma, WA 98403-2118 |
Second Address | Tacoma, WA 98403-2118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2006 |
Last Update Date | 08/07/2007 |