MEDICARE: DR. ROMEO SISON PUZON MD

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	208D00000X	General Practice Physician	MD00033805	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538190608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROMEO SISON PUZON MD

Provider Business Mailing Address
First Line	:	7501 92ND AVENUE CT SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98498-3973
Country	:	US
Telephone Number	:	253-588-0058
Fax Number	:	253-537-6425

Provider Business Practice Location Address
First Line	:	7501 92ND AVENUE CT SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98498-3973
Country	:	US
Telephone Number	:	253-588-0058
Fax Number	:	253-537-6425

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	03/05/2010

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