Provider Demographics
NPI:1972728434
Name:GOHL, ARIK WARREN (LMP)
Entity Type:Individual
Prefix:
First Name:ARIK
Middle Name:WARREN
Last Name:GOHL
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 S UNION AVE STE C30
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1334
Mailing Address - Country:US
Mailing Address - Phone:253-468-7200
Mailing Address - Fax:
Practice Address - Street 1:2302 S UNION AVE STE C30
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1334
Practice Address - Country:US
Practice Address - Phone:253-468-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013106174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist