Healthcare Provider Details

I. General information

NPI: 1386615912
Provider Name (Legal Business Name): PUGET SOUND GASTROENTEROLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N 34TH ST SUITE 101
SEATTLE WA
98103-8645
US

IV. Provider business mailing address

PO BOX 34888
SEATTLE WA
98124-1888
US

V. Phone/Fax

Practice location:
  • Phone: 206-838-1777
  • Fax: 206-838-1771
Mailing address:
  • Phone: 425-977-4620
  • Fax: 425-745-9836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number600388519
License Number StateWA

VIII. Authorized Official

Name: ALAN OLIVER
Title or Position: CEO
Credential: CEO
Phone: 786-530-3820