DR. GLENN J. KIETZER MD NPI 1003847179

NPI Information

  • NPI: 1003847179
  • Provider Name: DR. GLENN J. KIETZER, MD
  • Classification: General Practice - 208D00000X
  • Entity Type: Individual
  • Address: 15005 PACIFIC AVE
    SPANAWAY GENERAL MEDICAL
    TACOMA, WA
    ZIP 98444
  • Phone: (253) 537-3724

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NPI Details

DR. Glenn J. Kietzer, MD is a general practice in Tacoma, WA. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee DR. Glenn J. Kietzer, MD NPI is 1003847179. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

15005 PACIFIC AVE
SPANAWAY GENERAL MEDICAL
TACOMA, WA
ZIP 98444
Phone: (253) 537-3724
Fax: (253) 537-6425

The enumeration date for this NPI number is 7/6/2006 and was last updated on 5/7/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208D00000XGeneral PracticeMD00009584WASHINGTONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1AB03343MEDICARE ID-TYPE UNSPECIFIED
21195601MEDICAIDWASHINGTON
3A04892MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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