1164417101 NPI number — RYAN ALAN BIERMAN DPM

Table of content: RYAN ALAN BIERMAN DPM (NPI 1164417101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164417101 NPI number — RYAN ALAN BIERMAN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIERMAN
Provider First Name:
RYAN
Provider Middle Name:
ALAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164417101
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2728 E MAIN AVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
PUYALLUP
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98372-3198
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-841-2006
Provider Business Mailing Address Fax Number:
253-840-6691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17700 SE 272ND ST
Provider Second Line Business Practice Location Address:
SUITE 370
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98042-4951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-631-0585
Provider Business Practice Location Address Fax Number:
253-631-0596
Provider Enumeration Date:
09/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  PO00000712 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7109770 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8281297 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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