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General NPI Number Information
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NPI Number | 1437102167
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY ASSOCIATES, PLLC
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 500 LILLY RD NE STE B
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City | OLYMPIA
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State | WA
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Zip | 98506-5195
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Country | US
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Telephone | 360-413-8191
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Fax | 360-413-8110
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Provider Business Mailing Address
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Address Line | 500 LILLY RD NE STE 204
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City | OLYMPIA
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State | WA
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Zip | 98506-5197
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Country | US
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Telephone | 360-413-8191
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Fax | 360-413-8110
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | ERIC BOON
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Credential |
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Telephone | 480-567-0269
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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 |
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License Number State |
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