Healthcare Provider Details

I. General information

NPI: 1538190608
Provider Name (Legal Business Name): ROMEO SISON PUZON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 03/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 92ND AVENUE CT SW
LAKEWOOD WA
98498-3973
US

IV. Provider business mailing address

7501 92ND AVENUE CT SW
LAKEWOOD WA
98498-3973
US

V. Phone/Fax

Practice location:
  • Phone: 253-588-0058
  • Fax: 253-537-6425
Mailing address:
  • Phone: 253-588-0058
  • Fax: 253-537-6425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD00033805
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: