Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | OI60339265 | WA |
Y | 222Z00000X | Podiatrist | OI60339265 | WA |
N | 224P00000X | Prosthetist | PS60452668 | WA |
NPI | 1306271838 |
---|---|
Provider Name | Mr. Benjamin M Guenther |
First Address | Tyler, TX 75701-2109 |
Second Address | Tyler, TX 75701-2109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2013 |
Last Update Date | 02/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OI60339265 | STATE LICENSE (01) | WA |
PS60452668 | PROSTHETIC LICENSE (01) | WA |