Individual
MR. LARRY E WITHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
MADIGAN ARMY MEDICAL CTR, 9040A REID STREET, TACOMA, WA 98431-1100
(541) 922-3104
(541) 922-2951
Mailing address
MADIGAN ARMY MEDICAL CTR, 9040A REID STREET, TACOMA, WA 98431-1100
(541) 561-1420
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00965
OR
Other
Enumeration date
06/16/2005
Last updated
05/16/2013
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