Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | OI60560917 | WA |
N | 222Z00000X | Podiatrist | OI60560917 | WA |
Y | 224P00000X | Prosthetist | PS60560910 | WA |
NPI | 1336612753 |
---|---|
Provider Name | Mr. Richard Rex Marin |
First Address | Tacoma, WA 98405-4139 |
Second Address | Tacoma, WA 98405-4139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2019 |
Last Update Date | 08/01/2019 |