Individual
FASSIL BELAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1703 S MERIDIAN STE 305, PUYALLUP, WA 98371-7590
(253) 841-3933
Mailing address
1703 S MERIDIAN STE 305, PUYALLUP, WA 98371-7590
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA10004862
WA
363AM0700X
Medical Physician Assistant
Primary
PA10004862
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8451080
—
WA
01
—
P00671962
RR MEDICARE #
WA
Enumeration date
07/08/2006
Last updated
06/21/2019
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