Provider Demographics
NPI:1417039488
Name:EAR NOSE THROAT & PLASTIC SURGERY ASSOCIATES INC
Entity Type:Organization
Organization Name:EAR NOSE THROAT & PLASTIC SURGERY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PUIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-833-6241
Mailing Address - Street 1:310 6TH ST NE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4342
Mailing Address - Country:US
Mailing Address - Phone:253-833-6241
Mailing Address - Fax:
Practice Address - Street 1:310 6TH ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4342
Practice Address - Country:US
Practice Address - Phone:253-833-6241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601410204207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1609834258OtherNPI
WA7060890Medicaid
WA217110201Medicare PIN
WA217110200Medicare PIN
WAE22562Medicare UPIN