Healthcare Provider Details

I. General information

NPI: 1306364401
Provider Name (Legal Business Name): WASHINGTON GASTROENTEROLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 S CEDAR ST STE 330
TACOMA WA
98405-2318
US

IV. Provider business mailing address

3209 S 23RD ST STE 200
TACOMA WA
98405-1602
US

V. Phone/Fax

Practice location:
  • Phone: 253-272-5127
  • Fax: 253-272-0811
Mailing address:
  • Phone: 253-383-8342
  • Fax: 253-572-8204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNULL
# 6
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: RALPH J KATSMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 253-383-8342