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General NPI Number Information
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NPI Number | 1144362047
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Entity Type | Organization
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Legal Business Name | PROLIANCE SURGEONS INC PS
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14841 179TH AVE SE SUITE 220
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City | MONROE
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State | WA
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Zip | 98272-1127
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Country | US
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Telephone | 360-863-8141
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Fax | 360-805-9781
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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 | CEO
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Name | MR. DAVID G. FITZGERALD
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Credential |
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Telephone | 206-838-2590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | WA
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