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General NPI Number Information
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NPI Number | 1699701292
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Entity Type | Organization
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Legal Business Name | UROLOGY ASSOCIATES, LTD., P.S.
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 11/12/2008
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Provider Practice Location Address
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Address Line | 3525 ENSIGN RD NE SUITE A
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City | OLYMPIA
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State | WA
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Zip | 98506-5065
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Country | US
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Telephone | 360-456-4666
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Fax | 360-459-1566
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Provider Business Mailing Address
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Address Line | 3525 ENSIGN RD NE SUITE A
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City | OLYMPIA
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State | WA
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Zip | 98506-5065
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Country | US
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Telephone | 360-456-4666
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Fax | 360-459-1566
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK S PECKLER
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Credential | M.D..
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Telephone | 360-456-4666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MD00019049
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License Number State | WA
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