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General NPI Number Information
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NPI Number | 1679459978
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Entity Type | Individual
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Provider Name | SPENCER PATRICK FAYLES PA-S
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Gender | Male
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 4505 S MERIDIAN STE A
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City | PUYALLUP
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State | WA
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Zip | 98373-5002
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Country | US
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Telephone | 253-697-5780
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Fax | 253-864-2972
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Provider Business Mailing Address
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Address Line | 608 39TH AVE SW APT J302
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City | PUYALLUP
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State | WA
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Zip | 98373-3660
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Country | US
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Telephone | 801-706-8335
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PENDING
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License Number State | WA
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