Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD60552603 | WA |
N | 111NI0900X | Internist | MD60552603 | WA |
Y | 2080P0207X | Pediatric Hematology-Oncologist | MD60552603 | WA |
NPI | 1205128543 |
---|---|
Provider Name | Dr. Tyler Garrett Ketterl |
First Address | Seattle, WA 98105 |
Second Address | Seattle, WA 98105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2011 |
Last Update Date | 29/03/2018 |