Healthcare Provider Details

I. General information

NPI: 1437773173
Provider Name (Legal Business Name): SAMUEL NOBUYUKI PAROS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 COOKS HILL RD
CENTRALIA WA
98531-9071
US

IV. Provider business mailing address

1720 COOKS HILL RD
CENTRALIA WA
98531-9071
US

V. Phone/Fax

Practice location:
  • Phone: 360-827-8100
  • Fax: 360-827-8120
Mailing address:
  • Phone: 360-827-8100
  • Fax: 360-827-8120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD61596086
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: