# PUYALLUP VALLEY PEDIATRIC ASSOCIATES, P.S.

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

## Provider details

- **NPI number:** 1497962831
- **Authorized official:** TIMOTHY B JOLLEY M.D. (OWNER)
- **Authorized official phone:** (253) 848-1572

## Contact information

- **Practice address:** 1322 3RD ST SE, SUITE \#240, PUYALLUP, WA 98372-3771
- **Practice address phone:** (253) 848-1572
- **Practice address fax:** (253) 841-3719
- **Mailing address:** 1322 3RD ST SE, SUITE \#240, PUYALLUP, WA 98372-3771
- **Mailing address phone:** (253) 848-1572
- **Mailing address fax:** (253) 841-3719

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | NULL | Yes |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/16/2007
- **Last updated:** 08/22/2020