Healthcare Provider Details

I. General information

NPI: 1952068298
Provider Name (Legal Business Name): PUGET SOUND GASTROENTEROLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7114 W HOOD PL
KENNEWICK WA
99336-6712
US

IV. Provider business mailing address

7114 W HOOD PL
KENNEWICK WA
99336-6712
US

V. Phone/Fax

Practice location:
  • Phone: 509-734-4885
  • Fax: 509-734-2576
Mailing address:
  • Phone: 509-734-4885
  • Fax: 509-734-2576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALAN OLIVER
Title or Position: CEO
Credential: CEO
Phone: 786-530-3820