Organization Name: | PUGET SOUND SPECIALTY PHYSICIANS PLLC |
NPI Number: | 1144401704 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TINA M QUEVEDO (BILLING OFFICE SUPERVISOR) |
Mailing Address: | 19820 Hwy 410 East Bonney Lake |
State: | WA US |
Postal Code: | 98391 |
Phone Number: | 2538486656 |
Fax Number: | 2538406691 |
NPI Enumeration Date: | 11/23/2007 |
NPI Last Update Date: | 06/05/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |