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GRANT ALEXANDER YELLIOTT II

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA C

Contact information

Practice address
1717 S J ST, TACOMA, WA 98405-4933
(253) 426-6660
(253) 426-6250
Mailing address
505 S 336TH ST, SUITE 600, FEDERAL WAY, WA 98003-6328
(253) 838-6180
(253) 838-6418

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0221347
LIWA
WA
01
1493YE
BSWA
WA
05
8490021
WA
Enumeration date
02/01/2007
Last updated
04/02/2008
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