Healthcare Provider Details

I. General information

NPI: 1801900501
Provider Name (Legal Business Name): PUGET SOUND PHYSICIANS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 116TH AVENUE NE
BELLEVUE WA
98004
US

IV. Provider business mailing address

PO BOX 34960
SEATTLE WA
98124-1960
US

V. Phone/Fax

Practice location:
  • Phone: 425-688-5759
  • Fax: 425-688-5101
Mailing address:
  • Phone: 425-688-5759
  • Fax: 425-688-5101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHELLI I PEREIRA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 425-688-5759