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General NPI Number Information
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NPI Number | 1962525527
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Entity Type | Organization
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Legal Business Name | PUYALLUP ENDOCRINE & NUCLEAR MEDICINE CLINICS
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 07/22/2014
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Provider Practice Location Address
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Address Line | 1011 E MAIN AVE SUITE 302
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City | PUYALLUP
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State | WA
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Zip | 98372-6775
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Country | US
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Telephone | 253-841-2471
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Fax | 253-841-2472
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Provider Business Mailing Address
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Address Line | 1011 MAIN AVE E STE 302
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City | PUYALLUP
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State | WA
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Zip | 98372-6775
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Country | US
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Telephone | 253-841-2471
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Fax | 253-841-2472
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DONALD F DEVRIES
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Credential | M.D.
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Telephone | 253-841-2471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207UN0902X
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Taxonomy Name | Nuclear Imaging & Therapy Physician
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License Number | 601891662
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 601891662
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License Number State | WA
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