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General NPI Number Information
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NPI Number | 1306341706
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Entity Type | Individual
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Provider Name | POYA POURGHADERI DO
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Gender | Male
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 3124 S 19TH ST STE C320
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City | TACOMA
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State | WA
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Zip | 98405-2485
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Country | US
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Telephone | 253-301-5100
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Fax | 253-301-5101
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Provider Business Mailing Address
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Address Line | PO BOX 5299 MS: 820-5-PCO
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City | TACOMA
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State | WA
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Zip | 98415-0299
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | OP61508886
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License Number State | WA
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