Healthcare Provider Details

I. General information

NPI: 1144362047
Provider Name (Legal Business Name): PROLIANCE SURGEONS INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14841 179TH AVE SE SUITE 220
MONROE WA
98272-1127
US

IV. Provider business mailing address

720 OLIVE WAY SUITE 1505
SEATTLE WA
98101-1878
US

V. Phone/Fax

Practice location:
  • Phone: 360-863-8141
  • Fax: 360-805-9781
Mailing address:
  • Phone: 206-838-2590
  • Fax: 206-264-8689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DAVID G. FITZGERALD
Title or Position: CEO
Credential:
Phone: 206-838-2590