DR. TARA OETKEN (NPI# 1982067450) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982067450 |
| Entity Type | Individual |
| Full Name | DR. TARA OETKEN |
| Other Name | MRS. TARA OETKEN MCMAHON |
| Credential | M.D. |
| Practice Address |
1703 S Meridian Ste 101 Puyallup WA 98371-7590 |
| Practice Telephone | 2538483000 |
| Practice Fax Number | 2538458750 |
| Mailing Telephone | 2538483000 |
| Mailing Fax Number | 2538406514 |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2020-10-01 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | MD61066983 | WA | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4301 W Markham St, Slot 576, Little Rock, AR 722057101 | 5016865356 |
| Street Address |
1703 S MERIDIAN STE 101 |
| City | PUYALLUP |
| State | WA |
| Zip Code | 98371-7590 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275534919 | Roy J Park | Ophthalmology | 1703 S Meridian Ste 101, Puyallup, WA 98371-7590 | 2005-08-03 |
| 1144703984 | Alison Joy Pettinger | Plastic Surgery | 1703 S Meridian Ste 101, Puyallup, WA 98371 | 2018-09-07 |
| 1649413741 | Andrea Jones | Physician Assistant | 1703 S Meridian Ste 101, Puyallup, WA 98371-7590 | 2009-04-20 |
| 1881868370 | Evelyn X Fu | Ophthalmology | 1703 S Meridian Ste 101, Puyallup, WA 98371-7590 | 2008-04-16 |
| 1134276280 | Adam G Buchanan | Ophthalmology | 1703 S Meridian Ste 101, Puyallup, WA 98371-7590 | 2007-01-04 |
| 1326126814 | Susan L. Sullivan | Dermatology | 1703 S Meridian Ste 101, Puyallup, WA 98371-7590 | 2006-11-01 |
| 1053496919 | Cheryl Dawn Croft | Optometrist | 1703 S Meridian Ste 101, Puyallup, WA 98371-7590 | 2006-10-26 |
| 1144327289 | Rikk Jeremy Schlaffman | Optometrist | 1703 S Meridian Ste 101, Puyallup, WA 98371-7590 | 2006-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588141550 | Karen Lynn Sorensen | Massage Therapist | 922 Valley Ave Nw Suite 101, Puyallup, WA 98371 | 2018-07-23 |
| 1487140257 | Bradley Dupea | Specialist/Technologist | 5702 44th St Se, Puyallup, WA 98371 | 2018-07-05 |
| 1740778695 | Pedraum Heydari | Dentist | 109 N Meridian Suite A, Puyallup, WA 98371 | 2018-04-26 |
| 1487030359 | Jennifer Block | Dental Hygienist | 601 4th Ave Sw, Puyallup, WA 98371 | 2015-08-03 |
| 1023423431 | On Your Own Inc. | Registered Nurse | 1602 Peach Park Ln Nw, Puyallup, WA 98371 | 2014-06-24 |
| 1841614997 | Enrique Somera | Registered Nurse | 1107 29th St Nw, Puyallup, WA 98371 | 2014-02-10 |
| 1033540893 | Ching Ju Chuang | Dentist | 1002 N. Meridian, Suite 104a, Puyallup, WA 98371 | 2013-12-04 |
| 1104161876 | Denise L. Vanaman | Registered Nurse | 214 W. Main, Puyallup, WA 98371 | 2012-12-06 |
| 1336491018 | Tacoma School District | Physical Therapy Assistant | 1721 8th Ave. S.w., Puyallup, WA 98371 | 2012-10-05 |
| 1275882052 | Robert Francis Saxton | Health Educator | 1121 W. Stewart, Puyallup, WA 98371 | 2012-09-07 |
| Find all providers in zip 98371 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871835322 | Jason Lee Meeker | Dermatology | 2622 S. Meridian, Puyallup, WA 98373-1500 | 2013-03-22 |
| 1205975240 | June Kim | Dermatology | 1703 Meridian St S Ste 101, Puyallup, WA 98371-7590 | 2007-02-06 |
| 1912384710 | Philip Mclain | Dermatology | 2622 S Meridian, Puyallup, WA 98373-1500 | 2015-04-30 |
| 1326126814 | Susan L. Sullivan | Dermatology | 1703 S Meridian Ste 101, Puyallup, WA 98371-7590 | 2006-11-01 |
| 1033204938 | Cascade Eye & Skin Centers P.C. | Dermatology | 1703 S Meridian, Suite 101, Puyallup, WA 98371 | 2006-10-04 |
| 1912013814 | Robert J Martin | Dermatology | 1703 S Meridian, Suite 101, Puyallup, WA 98371 | 2006-08-22 |
| 1922017235 | Thomas Keith Vaughan | Dermatology | 929 E Main Ave, Ste 210, Puyallup, WA 98372-3116 | 2006-08-05 |
| 1770591679 | Brenda F Kodama | Dermatology | 1703 S Meridian, Ste 101, Puyallup, WA 98371-7590 | 2006-08-04 |
| 1942218847 | Julia E Jarvis | Dermatology | 1703 S Meridian, Ste 101, Puyallup, WA 98371-7590 | 2006-08-04 |
| 1891703781 | Jessica H Kim | Dermatology | 1703 S Meridian, Suite 101, Puyallup, WA 98371 | 2006-08-04 |
| Find all providers in PUYALLUP | ||||
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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.