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General NPI Number Information
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NPI Number | 1720059348
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Entity Type | Organization
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Legal Business Name | PUGET SOUND GASTROENTEROLOGY, PLLC
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Dates
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Enumeration Date | 01/31/2006
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 11027 MERIDIAN AVE N SUITE 100
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City | SEATTLE
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State | WA
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Zip | 98133-1705
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Country | US
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Telephone | 206-365-4492
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Fax | 206-368-3456
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Provider Business Mailing Address
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Address Line | PO BOX 34888
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City | SEATTLE
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State | WA
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Zip | 98124-1888
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Country | US
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Telephone | 425-977-4620
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Fax | 425-745-9836
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Authorized Official
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Title or Position | CEO
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Name | ALAN OLIVER
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Credential | CEO
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Telephone | 786-530-3820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 600388519
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License Number State | WA
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