Healthcare Provider Details

I. General information

NPI: 1912351289
Provider Name (Legal Business Name): ALEX JOSEPH FEJTA TAMPIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 S J ST FL 5
TACOMA WA
98405-4930
US

IV. Provider business mailing address

1608 S J ST FL 5
TACOMA WA
98405-4930
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-6731
  • Fax: 253-426-4322
Mailing address:
  • Phone: 253-426-6731
  • Fax: 253-426-4322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberMD61291537
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberFE61154516
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberFE61154516
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD61291537
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: