| Doctor Name: | FREDERICK JARL THYSELL |
| NPI Number: | 1285643544 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | MD00024540 |
| Business Practice Address: | 1416 Jesica Dr Selah, WA - 989421729 |
| Business Phone Number: | 5098233861 |
| Business Fax Number: | 5096973819 |
| Mailing Address: | 1416 Jesica Dr, SELAH |
| State: | WA |
| Postal Code: | 989421729 |
| Phone Number: | 5098233861 |
| Fax Number: | 5096973819 |
| NPI Enumeration Date: | 08/05/2006 |
| NPI Last Update Date: | 12/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | MD00024540 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |