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General NPI Number Information
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NPI Number | 1720498280
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Entity Type | Organization
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Legal Business Name | RAINIER PEDIATRICS, INC
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Dates
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Enumeration Date | 05/05/2014
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Last Update Date | 05/05/2014
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Provider Practice Location Address
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Address Line | 12904 94TH AVE E
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City | PUYALLUP
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State | WA
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Zip | 98373-5538
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Country | US
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Telephone | 253-841-3999
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Fax | 253-841-7311
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Provider Business Mailing Address
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Address Line | 12904 94TH AVE E
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City | PUYALLUP
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State | WA
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Zip | 98373-5538
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Country | US
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Telephone | 253-841-3999
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Fax | 253-841-7311
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. MICHAEL L PEARSON
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Credential | M.D.
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Telephone | 253-732-5508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | MD00014726
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License Number State | WA
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