1689646838 NPI number — PUGET SOUND GASTROENTEROLOGY, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689646838 NPI number — PUGET SOUND GASTROENTEROLOGY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUGET SOUND GASTROENTEROLOGY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689646838
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 34888
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98124-1888
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-977-4620
Provider Business Mailing Address Fax Number:
425-745-9836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19000 33RD AVE W
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036-4751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-686-7138
Provider Business Practice Location Address Fax Number:
425-745-4104
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OLIVER
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
786-530-3820

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  600388519 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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