JESSE LEE MIERZWIAK (NPI# 1013117803) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013117803 |
| Entity Type | Individual |
| Full Name | JESSE LEE MIERZWIAK |
| Credential | MD |
| Practice Address |
3124 S 19th St Ste 320 Tacoma WA 98405-2433 |
| Practice Telephone | 2533015100 |
| Mailing Telephone | 2533015100 |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2013-02-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | MD60271040 | WA | Allopathic & Osteopathic Physicians |
| Street Address |
3124 S 19TH ST STE 320 |
| City | TACOMA |
| State | WA |
| Zip Code | 98405-2433 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407848559 | Mark Schomogyi | Internal Medicine | 3124 S 19th St, Ste 240, Tacoma, WA 98405-2433 | 2005-08-16 |
| 1083052583 | Kimberley Ann Marin | Nurse Practitioner | 3124 S 19th St, Ste 340, Tacoma, WA 98405-2433 | 2013-06-06 |
| 1699066530 | Hossein Pakzad Sedigh | Orthopaedic Surgery | 3124 S 19th St, Ste 340, Tacoma, WA 98405-2433 | 2011-04-26 |
| 1790004844 | Catherine Grace Engibous Holder | Physician Assistant | 3124 S 19th St, Tacoma, WA 98405-2433 | 2010-05-27 |
| 1407017510 | Lili Yao | Internal Medicine | 3124 S 19th St, Tacoma, WA 98405-2433 | 2008-06-20 |
| 1033305826 | Deo Samson Macabio Perez | Physician Assistant | 3124 S 19th St, Suite 320, Tacoma, WA 98405-2433 | 2007-09-14 |
| 1750582235 | Bobby Anthony Stevens | Surgery | 3124 S 19th St, Ste C220, Tacoma, WA 98405-2433 | 2007-05-30 |
| 1386709384 | Viet H Nguyen | Registered Nurse | 3124 S 19th St, Ste 140, Tacoma, WA 98405-2433 | 2006-12-27 |
| 1538241930 | John Anthony Vaccaro | Urology | 3124 S 19th St, Ste 320, Tacoma, WA 98405-2433 | 2006-10-19 |
| 1235210493 | Douglas E Sutherland | Urology | 3124 S 19th St, Ste 240, Tacoma, WA 98405-2433 | 2006-10-17 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609486026 | Joanna Christine Hope | Physician Assistant | 2502 S Union Avenue, Tacoma, WA 98405 | 2020-08-01 |
| 1467077891 | Richard Jimenez | Student in an Organized Health Care Education/Training Program | 1202 M.l.k. Jr Way Suite #310, Tacoma, WA 98405 | 2020-06-11 |
| 1669008785 | Mariana Sanchez Corona | Behavior Technician | 1901 S Union Ave Allenmore Building B, Tacoma, WA 98405 | 2020-03-20 |
| 1811534845 | Jasmine Gregory | Social Worker | 311 Martin Luther King Jr. Way, Ms:315-c2-php, Tacoma, WA 98405 | 2019-12-10 |
| 1548807506 | Holly Rebecca Brezynski | Student in an Organized Health Care Education/Training Program | Fresenius Kindney Care - Home Therapies Department, 1717 South J Street, Tacoma, WA 98405 | 2019-12-09 |
| 1972064392 | Logan Brau | Student in an Organized Health Care Education/Training Program | 1202 M.l.k. Jr Way, Tacoma, WA 98405 | 2019-03-28 |
| 1629532536 | Preferred Orthotic and Prosthetic Services Inc | Prosthetic/Orthotic Supplier | 1708 Yakima Ave Ste 60, Tacoma, WA 98405 | 2019-01-24 |
| 1669945911 | Heidi Weakley | Counselor | 1001 S Yakima Ave, Suite 5, Tacoma, WA 98405 | 2019-01-09 |
| 1972074011 | Taviance Benet Laster | Behavior Technician | 1416 S 9th St, Tacoma, WA 98405 | 2018-12-16 |
| 1336618040 | Bailey Bangerter | Physician Assistant | 1901 South Union, A-233, Tacoma, WA 98405 | 2018-11-26 |
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| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730447731 | Daniel Christian Sackman | Urology | 3124 South 19th St #c320, Tacoma, WA 98405-3011 | 2012-04-26 |
| 1073886438 | Peter John Minich | Urology | 3124 S 19th St Ste 240, Tacoma, WA 98405-2433 | 2012-02-15 |
| 1780909184 | Matthew Michael Banti | Urology | Urology Service Madigan Army Ctr, 9040 Jackson Ave, Tacoma, WA 98431-1100 | 2010-03-29 |
| 1942436886 | Charles Y Chang | Urology | 3124 S 19th St # 320, Tacoma, WA 98405-2433 | 2009-06-05 |
| 1649442682 | Patrick Shannon Mcdonough | Urology | Madigan Army Medical Center - Bldg 9040, Fitzsimmons Drive, Tacoma, WA 98431-0001 | 2008-03-31 |
| 1063525723 | Scott Paul Cuda | Urology | Madigan Army Medical Center 9040 Jackson Avenu, Tacoma, WA 98431-7282 | 2006-08-16 |
| 1306879366 | Jack Ryan Walter | Urology | 9040 Jackson Ave Mamc Urology, Tacoma, WA 98431 | 2006-07-09 |
| 1134472798 | Carolyn Anne Salter | Urology | 9040 Jackson Ave, Tacoma, WA 98431-0001 | 2012-10-19 |
| 1477839066 | Richard Johnston | Urology | 1708 Yakima Ave, Suite 310, Tacoma, WA 98405-5307 | 2011-10-26 |
| 1902137763 | Franciscan Medical Group | Urology | 1624 S I St, Ste 204, Tacoma, WA 98405-5016 | 2010-01-19 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.