Provider Demographics
NPI:1922029875
Name:THIESSEN, ABRAM ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ABRAM
Middle Name:ROBERT
Last Name:THIESSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 N NARROWS DR
Mailing Address - Street 2:UNIT #B304
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-1500
Mailing Address - Country:US
Mailing Address - Phone:253-503-6736
Mailing Address - Fax:866-899-1609
Practice Address - Street 1:1709 DOCK ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3204
Practice Address - Country:US
Practice Address - Phone:253-682-1710
Practice Address - Fax:253-682-1714
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015129207R00000X, 207RH0003X
ORMD25763207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A08627Medicare UPIN