Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DE00009999 | WA |
Y | 213EG0000X | General Practice | DE00009999 | WA |
NPI | 1003826835 |
---|---|
Provider Name | Timothy George Gutmann |
First Address | Yakima, WA 98908 |
Second Address | Yakima, WA 98908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 10/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5046958 | (05) | WA |