Individual
DR. GLENN J. KIETZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15005 PACIFIC AVE, SPANAWAY GENERAL MEDICAL, TACOMA, WA 98444
(253) 537-3724
(253) 537-6425
Mailing address
15005 PACIFIC AVE, SPANAWAY GENERAL MEDICAL, TACOMA, WA 98444
(253) 537-3724
(253) 537-6425
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
MD00009584
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1195601
—
WA
Enumeration date
07/06/2006
Last updated
05/07/2014
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