Healthcare Provider Details

I. General information

NPI: 1720498280
Provider Name (Legal Business Name): RAINIER PEDIATRICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12904 94TH AVE E
PUYALLUP WA
98373-5538
US

IV. Provider business mailing address

12904 94TH AVE E
PUYALLUP WA
98373-5538
US

V. Phone/Fax

Practice location:
  • Phone: 253-841-3999
  • Fax: 253-841-7311
Mailing address:
  • Phone: 253-841-3999
  • Fax: 253-841-7311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD00014726
License Number StateWA

VIII. Authorized Official

Name: DR. MICHAEL L PEARSON
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 253-732-5508