Provider Demographics
NPI:1205960226
Name:PUGET SOUND ALLERGY ASTHMA AND IMMUNOLOGY
Entity type:Organization
Organization Name:PUGET SOUND ALLERGY ASTHMA AND IMMUNOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:235-383-4721
Mailing Address - Street 1:1901 S UNION AVE
Mailing Address - Street 2:SUITE B6010
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1702
Mailing Address - Country:US
Mailing Address - Phone:253-383-4721
Mailing Address - Fax:253-627-4296
Practice Address - Street 1:34509 9TH AVE S
Practice Address - Street 2:SUITE 207
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6700
Practice Address - Country:US
Practice Address - Phone:253-662-5667
Practice Address - Fax:253-627-4296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026151207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7112261Medicaid
WA8853550Medicare PIN
WAQ76616Medicare UPIN
WAA03350Medicare UPIN
WAGAB33753Medicare PIN
WA8864200Medicare PIN