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Individual
DR. JAC R TIECHNER
Active
Individual
DR. JAC R TIECHNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
PO00000207
WA
213ER0200X
Radiology Podiatrist
PO00000207
WA
213ES0103X
Foot & Ankle Surgery Podiatrist
PO00000207
WA
213ES0131X
Foot Surgery Podiatrist
PO00000207
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0035677
WA STATE LABOR AND INDUSTRY GROUP #
WA
05
—
1013614
—
WA
01
—
15520000
WA STATE LABOR AND INDUSTRY
WA
01
—
480661080
PALMETTO GBA RAILROAD MEDICARE PART B
WA
Enumeration date
06/09/2006
Last updated
05/01/2008
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