Basic Information
| Provider Information | |||||||||
| NPI: | 1558334490 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAMURIAN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3124 S 19TH ST | ||||||||
| Address2: | STE 340 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984052433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534597000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3124 S 19TH ST | ||||||||
| Address2: | STE 340 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984052433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534597000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2006 | ||||||||
| LastUpdateDate: | 08/06/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | C53136 | CA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0114X | C53136 | CA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | 207XX0801X | C53136 | CA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma | 207X00000X | MD60284372 | WA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0801X | MD60284372 | WA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma | 207XX0005X | MD60284372 | WA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207XS0114X | MD60284372 | WA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 4292600001 | 01 | CA | DME SUPPLIER NUMBER | OTHER |