Healthcare Provider Details

I. General information

NPI: 1497755797
Provider Name (Legal Business Name): DERMATOLOGY & ALLERGY SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 W BAY DR NW SUITE 301
OLYMPIA WA
98502-4958
US

IV. Provider business mailing address

304 W BAY DR NW SUITE 301
OLYMPIA WA
98502-4953
US

V. Phone/Fax

Practice location:
  • Phone: 360-413-8760
  • Fax: 360-413-8839
Mailing address:
  • Phone: 360-413-8760
  • Fax: 360-413-8839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: J. MARK BAUER
Title or Position: PARTNER
Credential: MD
Phone: 360-413-8297