Healthcare Provider Details

I. General information

NPI: 1417039488
Provider Name (Legal Business Name): EAR NOSE THROAT & PLASTIC SURGERY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 6TH ST NE
AUBURN WA
98002-4342
US

IV. Provider business mailing address

310 6TH ST NE
AUBURN WA
98002-4342
US

V. Phone/Fax

Practice location:
  • Phone: 253-833-6241
  • Fax:
Mailing address:
  • Phone: 253-833-6241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number601410204
License Number StateWA

VIII. Authorized Official

Name: DR. CHRISTINE M PUIG
Title or Position: PRESIDENT
Credential: MD
Phone: 253-833-6241