Healthcare Provider Details

I. General information

NPI: 1720059348
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

11027 MERIDIAN AVE N SUITE 100
SEATTLE WA
98133-1705
US

IV. Provider business mailing address

PO BOX 34888
SEATTLE WA
98124-1888
US

V. Phone/Fax

Practice location:
  • Phone: 206-365-4492
  • Fax: 206-368-3456
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