Organization
WESTERN WASHINGTON MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEROME TILLINGER (CEO)
(425) 259-4041
Entity
Organization
Contact information
Practice address
1909 214TH ST SE, SUITE 211, BOTHELL, WA 98021-4412
(425) 420-1655
Mailing address
1728 W MARINE VIEW DR, SUITE 110, EVERETT, WA 98201-2094
(425) 259-4041
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
207RC0000X
WA
174400000X
Specialist
Primary
207RE0101X
WA
174400000X
Specialist
207RG0100X
WA
174400000X
Specialist
207Y00000X
WA
174400000X
Specialist
213E00000X
WA
174400000X
Specialist
291U00000X
WA
207R00000X
Internal Medicine Physician
207R00000X
WA
Other
Enumeration date
06/08/2010
Last updated
11/23/2011
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