Healthcare Provider Details

I. General information

NPI: 1710103593
Provider Name (Legal Business Name): CAMERON E BUHL L.M.P
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: C C BUHL L.M.P

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2722 S MELROSE ST
TACOMA WA
98405-2609
US

IV. Provider business mailing address

2722 S MELROSE ST
TACOMA WA
98405-2609
US

V. Phone/Fax

Practice location:
  • Phone: 253-230-4045
  • Fax:
Mailing address:
  • Phone: 253-230-4045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00020999
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: