Healthcare Provider Details

I. General information

NPI: 1558455642
Provider Name (Legal Business Name): PUGET SOUND OTOLARYNGOLOGY INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21616 76TH AVE W #112
EDMONDS WA
98026-7512
US

IV. Provider business mailing address

21616 76TH AVE W #112
EDMONDS WA
98026-7512
US

V. Phone/Fax

Practice location:
  • Phone: 425-775-6651
  • Fax: 425-670-6718
Mailing address:
  • Phone: 425-775-6651
  • Fax: 425-670-6718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MAUREEN M MILLER
Title or Position: OFFICE MANAGER
Credential:
Phone: 425-775-6651