MEDICARE: PUGET SOUND ALLERGY ASTHMA & IMMUNOLOGY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207KI0005X	Clinical & Laboratory Immunology (Allergy & Immunology) Physician	MD00026151	WA

General Provider Information

NPI Number	:	1043200942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUGET SOUND ALLERGY ASTHMA & IMMUNOLOGY

Provider Business Mailing Address
First Line	:	1901 S UNION AVE
Second Line	:	STE B-6010
City	:	TACOMA
State	:	WA
Zip	:	98405-1806
Country	:	US
Telephone Number	:	253-383-4721
Fax Number	:	253-627-4296

Provider Business Practice Location Address
First Line	:	1901 S UNION AVE
Second Line	:	STE B-6010
City	:	TACOMA
State	:	WA
Zip	:	98405-1702
Country	:	US
Telephone Number	:	253-383-4721
Fax Number	:	253-627-4296

Authorized Official
Title or Position	:	PHYSICIAN AND OWNER
Name	:	ARTHUR B VEGH
Credential	:	MD
Telephone Number	:	253-383-4721

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	03/03/2008

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