Healthcare Provider Details

I. General information

NPI: 1699718973
Provider Name (Legal Business Name): PROLIANCE SURGEONS INC., P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 SW 43RD ST SUITE 201
RENTON WA
98055-4801
US

IV. Provider business mailing address

720 OLIVE WAY SUITE 1505
SEATTLE WA
98101-1878
US

V. Phone/Fax

Practice location:
  • Phone: 425-228-6076
  • Fax: 425-226-5224
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: 206-838-2599