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General NPI Number Information
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NPI Number | 1134169931
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Entity Type | Organization
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Legal Business Name | PROLIANCE SURGEONS INC., P.S.
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1600 E JEFFERSON ST SUITE 101
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City | SEATTLE
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State | WA
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Zip | 98122-5698
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Country | US
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Telephone | 206-328-0100
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Fax | 206-320-2102
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Provider Business Mailing Address
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Address Line | 720 OLIVE WAY SUITE 1505
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City | SEATTLE
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State | WA
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Zip | 98101-1878
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Country | US
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Telephone | 206-838-2590
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Fax | 206-264-8689
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Authorized Official
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Title or Position | CLAIMS MANAGER
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Name | MR. DAVID G FITZGERALD
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Credential |
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Telephone | 206-838-2599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State | WA
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