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General NPI Number Information
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NPI Number | 1932635133
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Entity Type | Organization
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Legal Business Name | PROLIANCE SURGEONS, INC., P.S.
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Dates
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Enumeration Date | 05/08/2017
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Last Update Date | 05/08/2017
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Provider Practice Location Address
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Address Line | 515 MINOR AVE SUITE 160
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City | SEATTLE
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State | WA
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Zip | 98104-2120
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Country | US
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Telephone | 206-701-6954
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Fax | 206-628-4321
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Provider Business Mailing Address
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Address Line | 805 MADISON ST SUITE 901
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City | SEATTLE
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State | WA
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Zip | 98104-1172
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Country | US
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Telephone | 206-264-8100
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. DAVID G. FITZGERALD
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Credential |
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Telephone | 206-838-2599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 601484763
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License Number State | WA
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