Healthcare Provider Details

I. General information

NPI: 1740281344
Provider Name (Legal Business Name): PUYALLUP DERMATOLOGY CLINIC INC P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2622 S MERIDIAN
PUYALLUP WA
98373-1500
US

IV. Provider business mailing address

929 E MAIN AVE SUITE 210
PUYALLUP WA
98372-3116
US

V. Phone/Fax

Practice location:
  • Phone: 253-841-2453
  • Fax: 253-840-5519
Mailing address:
  • Phone: 253-841-2453
  • Fax: 253-840-5519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00038522
License Number StateWA

VIII. Authorized Official

Name: DR. JASON MEEKER
Title or Position: OWNER
Credential: M.D.
Phone: 253-841-2453