Healthcare Provider Details

I. General information

NPI: 1053322156
Provider Name (Legal Business Name): RACHAEL D ELROD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 S MERIDIAN SUITE 101
PUYALLUP WA
98371
US

IV. Provider business mailing address

1703 S MERIDIAN SUITE 101
PUYALLUP WA
98371
US

V. Phone/Fax

Practice location:
  • Phone: 253-848-3000
  • Fax: 253-840-6514
Mailing address:
  • Phone: 253-848-3000
  • Fax: 253-840-6514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD00043736
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: