Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 60113820 | WA |
NPI | 1033186325 |
---|---|
Provider Name | Ziga Tretjak |
First Address | Pasco, WA 99301-8028 |
Second Address | Richland, WA 99352 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2006 |
Last Update Date | 05/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0053CQ | BLUE CROSS BLUE SHIELD (01) | TX |
0259824 | LABOR & INDUSTRIES (01) | WA |
113447001 | (05) | TX |
8556128 | (05) | WA |
G32518 | (02) | TX |