Provider Demographics
NPI:1265558993
Name:SOUTH AUBURN MEDICAL CLINIC INC
Entity type:Organization
Organization Name:SOUTH AUBURN MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:AFLATOONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-804-9190
Mailing Address - Street 1:3830 A ST SE STE 204
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-8611
Mailing Address - Country:US
Mailing Address - Phone:253-804-9190
Mailing Address - Fax:253-804-5797
Practice Address - Street 1:3830 A ST SE STE 204
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-8611
Practice Address - Country:US
Practice Address - Phone:253-804-9190
Practice Address - Fax:253-804-5797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602338317207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4121SOOtherREGENCE