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General NPI Number Information
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NPI Number | 1639257074
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Entity Type | Individual
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Provider Name | HERMAN H. JOLING III RT (R)
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Gender | Male
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 07/25/2007
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Provider Practice Location Address
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Address Line | 1519 ALASKAN WAY SOUTH
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City | SEATTLE
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State | WA
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Zip | 98134-1102
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Country | US
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Telephone | 206-217-6280
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Fax | 206-217-6286
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Provider Business Mailing Address
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Address Line | 2015 WALNUT GROVE LN
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City | CENTRAL POINT
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State | OR
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Zip | 97502-3560
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Country | US
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Telephone | 541-665-1060
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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