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General NPI Number Information
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NPI Number | 1811015399
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Entity Type | Organization
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Legal Business Name | SURGICAL WEIGHT LOSS CLINIC PLLC
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3716 PACIFIC AVE SUITE B
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City | TACOMA
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State | WA
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Zip | 98418-7836
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Country | US
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Telephone | 253-472-9850
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Fax |
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Provider Business Mailing Address
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Address Line | 3716 PACIFIC AVE SUITE B
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City | TACOMA
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State | WA
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Zip | 98418-7836
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Country | US
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Telephone | 253-472-9850
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Fax |
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Authorized Official
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Title or Position | OWNER & SURGEON
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Name | DR. SAMUEL ROSS FOX
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Credential | MD
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Telephone | 253-472-9850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD0002094
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD00005293
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State | WA
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