Basic Information
| Provider Information | |||||||||
| NPI: | 1063621613 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANDRA TATRO PS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2108 | ||||||||
| Address2: | |||||||||
| City: | PORT ANGELES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983620379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604526808 | ||||||||
| FaxNumber: | 3604170127 | ||||||||
| Practice Location | |||||||||
| Address1: | 1021 CAROLINE ST | ||||||||
| Address2: | |||||||||
| City: | PORT ANGELES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983623901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604526808 | ||||||||
| FaxNumber: | 3604170127 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 09/06/2007 | ||||||||
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| AuthorizedOfficialLastName: | TATRO | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3604526808 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD00043009 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.