Individual
JON R TACEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
3100 SE MILE HILL DR STE A, PORT ORCHARD, WA 98366-2962
(360) 895-4844
(360) 895-4834
Mailing address
3100 SE MILE HILL DR STE A, PORT ORCHARD, WA 98366-2962
(360) 895-4844
(360) 895-4834
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MA60018860
WA
Other
Enumeration date
05/14/2010
Last updated
05/14/2010
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