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General NPI Number Information
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NPI Number | 1003992090
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Entity Type | Organization
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Legal Business Name | ADVANCED GASTROENTEROLOGY, PLLC
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 3250 SE 164TH AVE STE 205
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City | VANCOUVER
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State | WA
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Zip | 98683-9313
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Country | US
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Telephone | 360-946-4313
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Fax | 360-576-1133
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Provider Business Mailing Address
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Address Line | 3250 SE 164TH AVE STE 205
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City | VANCOUVER
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State | WA
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Zip | 98683-9313
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Country | US
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Telephone | 360-946-4313
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Fax | 360-314-2067
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Authorized Official
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Title or Position | PARTNER
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Name | SAMUEL K SIM
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Credential |
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Telephone | 360-946-4313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD00042129
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License Number State | WA
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