Organization
EAR,NOSE,THROAT & ALLERGY ASSOCIATES PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL BENNETT (OWNER)
(253) 770-8454
Entity
Organization
Contact information
Practice address
104 27TH AVE SE, PUYALLUP, WA 98374-1145
(253) 770-8454
Mailing address
104 27TH AVE SE, PUYALLUP, WA 98374-1145
(253) 770-9000
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7078017
—
WA
Enumeration date
01/02/2007
Last updated
01/17/2008
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