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General NPI Number Information
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NPI Number | 1255805628
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Entity Type | Organization
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Legal Business Name | FRED THYSELL MD
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Dates
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Enumeration Date | 01/18/2019
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Last Update Date | 01/18/2019
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Provider Practice Location Address
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Address Line | 2807 W WASHINGTON AVE STE 117
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City | YAKIMA
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State | WA
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Zip | 98903-1367
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Country | US
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Telephone | 509-469-1903
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Fax | 509-469-1905
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Provider Business Mailing Address
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Address Line | PO BOX 8051
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City | YAKIMA
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State | WA
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Zip | 98908-0051
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Country | US
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Telephone | 509-469-1903
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Fax | 509-469-1905
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | FREDERICK JARL THYSELL
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Credential | MD
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Telephone | 509-823-3861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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