Healthcare Provider Details

I. General information

NPI: 1043200942
Provider Name (Legal Business Name): PUGET SOUND ALLERGY ASTHMA & IMMUNOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S UNION AVE STE B-6010
TACOMA WA
98405-1702
US

IV. Provider business mailing address

1901 S UNION AVE STE B-6010
TACOMA WA
98405-1806
US

V. Phone/Fax

Practice location:
  • Phone: 253-383-4721
  • Fax: 253-627-4296
Mailing address:
  • Phone: 253-383-4721
  • Fax: 253-627-4296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License NumberMD00026151
License Number StateWA

VIII. Authorized Official

Name: ARTHUR B VEGH
Title or Position: PHYSICIAN AND OWNER
Credential: MD
Phone: 253-383-4721