Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | OI00000003 | WA |
N | 222Z00000X | Podiatrist | OI00000003 | WA |
Y | 224P00000X | Prosthetist | PS00000004 | WA |
NPI | 1417096694 |
---|---|
Provider Name | Mr. Karl W Entenmann |
First Address | Tacoma, WA 98405-2308 |
Second Address | Federal Way, WA 98003-8722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 17/05/2013 |