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General NPI Number Information
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NPI Number | 1467859645
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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 | 12/03/2014
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Last Update Date | 12/03/2014
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Provider Practice Location Address
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Address Line | 6520 226TH PL SE SUITE 205
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City | ISSAQUAH
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State | WA
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Zip | 98027-8969
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Country | US
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Telephone | 425-392-8611
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Fax | 425-392-9012
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Provider Business Mailing Address
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Address Line | 805 MADISON ST SUITE 901
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City | SEATTLE
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State | WA
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Zip | 98104-1172
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Country | US
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Telephone | 206-264-8100
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Fax |
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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 | 206-838-2599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 601484763
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 601484763
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License Number State | WA
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