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Individual

MR. KENNETH LEO FLECK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
910 TACOMA AVE S, TACOMA, WA 98402-2104
(253) 708-4033
(253) 798-4043
Mailing address
5012 161ST ST E, TACOMA, WA 98446-3810
(253) 536-1232
(253) 536-9028

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA10001613
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
GAB36263
WA
Enumeration date
10/11/2006
Last updated
07/08/2007
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