MEDICARE: DR. BRUCE JOHN TAPPER PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY1976	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144398827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE JOHN TAPPER PH.D

Provider Business Mailing Address
First Line	:	281 LANE DE CHANTEL # A
Second Line	:
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368-9671
Country	:	US
Telephone Number	:	360-379-3500
Fax Number	:	360-379-8866

Provider Business Practice Location Address
First Line	:	281 LANE DE CHANTEL # A
Second Line	:
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368-9671
Country	:	US
Telephone Number	:	360-379-3500
Fax Number	:	360-379-8866

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	11/16/2007

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