Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | PS00000193 | WA |
NPI | 1477696359 |
---|---|
Provider Name | Mr. Douglas G Tyler |
First Address | Tacoma, WA 98405-2308 |
Second Address | Tacoma, WA 98405-2308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 17/05/2013 |