# EAR, NOSE, THROAT & ALLERGY ASSOICATIES PS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104149210
- **Authorized official:** RANDALL BENNETT M.D. (OWNER)
- **Authorized official phone:** (253) 770-8454

## Contact information

- **Practice address:** 104 27TH AVE SE, PUYALLUP, WA 98374-1145
- **Practice address phone:** (253) 770-8454
- **Practice address fax:** (253) 770-8992
- **Mailing address:** 104 27TH AVE SE, PUYALLUP, WA 98374-1145
- **Mailing address phone:** (253) 770-8454
- **Mailing address fax:** (253) 770-8992

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 231H00000X | Audiologist | LD60130143 | WA | Yes |

## Other

- **Enumeration date:** 03/03/2010
- **Last updated:** 03/03/2010