Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | MD00032266 | WA |
NPI | 1003827171 |
---|---|
Provider Name | Keith F Dahlhauser |
First Address | Puyallup, WA 98371 |
Second Address | Puyallup, WA 98371 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 15/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8353237 | (05) | WA |
H87289 | (02) |