| Doctor Name: | DR. GLENN J. KIETZER |
| NPI Number: | 1003847179 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | MD00009584 |
| Business Practice Address: | 15005 Pacific Ave Spanaway General Medical Tacoma, WA - 98444 |
| Business Phone Number: | 2535373724 |
| Business Fax Number: | 2535376425 |
| Mailing Address: | 15005 Pacific Ave, Spanaway General Medical TACOMA |
| State: | WA |
| Postal Code: | 98444 |
| Phone Number: | 2535373724 |
| Fax Number: | 2535376425 |
| NPI Enumeration Date: | 07/06/2006 |
| NPI Last Update Date: | 05/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | MD00009584 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |