Healthcare Provider Details

I. General information

NPI: 1467666701
Provider Name (Legal Business Name): OBJECTIVE DIAGNOSTICS & RESEARCH PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4803 CENTER ST
TACOMA WA
98409-2319
US

IV. Provider business mailing address

4803 CENTER ST
TACOMA WA
98409-2319
US

V. Phone/Fax

Practice location:
  • Phone: 253-460-7234
  • Fax:
Mailing address:
  • Phone: 253-460-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number StateWA

VIII. Authorized Official

Name: DR. MARK ALLEN WOODHAM
Title or Position: OWNER
Credential: D.C.
Phone: 253-460-7234