Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
Y | 224P00000X | Prosthetist |
NPI | 1144669342 |
---|---|
Provider Name | Glen Pigman |
First Address | Tacoma, WA 98405-2126 |
Second Address | Tacoma, WA 98405-2126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2013 |
Last Update Date | 20/06/2013 |