Healthcare Provider Details

I. General information

NPI: 1730278086
Provider Name (Legal Business Name): GAD B KLETTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S L ST
TACOMA WA
98405-3720
US

IV. Provider business mailing address

311 S L ST
TACOMA WA
98405-3720
US

V. Phone/Fax

Practice location:
  • Phone: 253-792-6630
  • Fax:
Mailing address:
  • Phone: 253-792-6630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00033216
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberMD00033216
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: