Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD60450293 | WA |
NPI | 1073839817 |
---|---|
Provider Name | Tracy Hamblin |
First Address | Olympia, WA 98507-0368 |
Second Address | Olympia, WA 98502-8654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2010 |
Last Update Date | 11/09/2014 |