Healthcare Provider Details

I. General information

NPI: 1114189743
Provider Name (Legal Business Name): PUGET SOUND HEARING AND BALANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9714 3RD AVE NE SUITE 100
SEATTLE USA
98115
UM

IV. Provider business mailing address

PO BOX 59325
RENTON WA
98058-2325
US

V. Phone/Fax

Practice location:
  • Phone: 206-523-5584
  • Fax: 206-523-5882
Mailing address:
  • Phone: 425-204-6958
  • Fax: 206-523-5882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD27287
License Number StateWA

VIII. Authorized Official

Name: SANDY ARTHALONY
Title or Position: BILLER
Credential:
Phone: 425-204-6958