Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD60271040 | WA |
NPI | 1013117803 |
---|---|
Provider Name | Jesse Lee Mierzwiak |
First Address | Tacoma, WA 98405-2433 |
Second Address | Tacoma, WA 98405-2433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2007 |
Last Update Date | 26/02/2013 |