Provider Demographics
NPI:1245926195
Name:PUGET SOUND MEDICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:PUGET SOUND MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:FAROOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-969-6057
Mailing Address - Street 1:9249 25TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-2812
Mailing Address - Country:US
Mailing Address - Phone:425-585-2452
Mailing Address - Fax:425-209-3368
Practice Address - Street 1:21616 76TH AVE W STE 202
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7543
Practice Address - Country:US
Practice Address - Phone:425-585-2452
Practice Address - Fax:425-209-3368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty