Healthcare Provider Details

I. General information

NPI: 1093741076
Provider Name (Legal Business Name): DEER PARK URGENT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 SOUTH PARK
DEER PARK WA
99006
US

IV. Provider business mailing address

PO BOX 340
DEER PARK WA
99006-0340
US

V. Phone/Fax

Practice location:
  • Phone: 509-262-9000
  • Fax: 509-276-3034
Mailing address:
  • Phone: 509-262-9000
  • Fax: 509-276-3034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JULIE A MORAN
Title or Position: OWNER/PRACTICIONER
Credential: M.D.
Phone: 509-276-5005