Provider Demographics
NPI:1558369272
Name:TACOMA UROLOGY CENTER PLLC
Entity Type:Organization
Organization Name:TACOMA UROLOGY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:U
Authorized Official - Last Name:FINNERTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-272-8822
Mailing Address - Street 1:1802 YAKIMA AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4499
Mailing Address - Country:US
Mailing Address - Phone:253-272-8822
Mailing Address - Fax:253-272-8855
Practice Address - Street 1:1802 YAKIMA AVE
Practice Address - Street 2:STE 205
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4499
Practice Address - Country:US
Practice Address - Phone:253-272-8822
Practice Address - Fax:253-272-8855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA19475208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAB35261Medicare ID - Type Unspecified