Organization
DIMITRI KUZNETSOV, M.D. PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY E. KEYES (CLINIC MANAGER)
(360) 385-2905
Entity
Organization
Contact information
Practice address
1274 7TH ST STE B, PORT TOWNSEND, WA 98368-2404
(360) 385-2905
Mailing address
1274 7TH ST STE B, PORT TOWNSEND, WA 98368-2404
(360) 385-2905
Taxonomy
Speciality
Code
Description
License number
State
2088P0231X
Pediatric Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1120955
—
WA
Enumeration date
06/27/2007
Last updated
11/28/2007
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