Healthcare Provider Details

I. General information

NPI: 1831492537
Provider Name (Legal Business Name): PROLIANCE SURGEONS INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2010
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 116TH AVE NE SUITE D-4
BELLEVUE WA
98004-3058
US

IV. Provider business mailing address

805 MADISON ST. SUITE 901
SEATTLE WA
98104-1172
US

V. Phone/Fax

Practice location:
  • Phone: 425-283-5230
  • Fax: 425-283-5236
Mailing address:
  • Phone: 206-264-8100
  • Fax: 206-264-8689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number601484763
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number601484763
License Number StateWA

VIII. Authorized Official

Name: MR. DAVID G. FITZGERALD
Title or Position: CEO
Credential:
Phone: 206-838-2599