Organization
PROLIANCE SURGEONS, INC., P.S.
Active
Other names
Proliance Puyallup Surgeons
Organization subpart
No
Provider details
NPI number
Authorized official
CORI M. PLEASANT (MGR PROVIDER RELATIONS/ENROLLMENT)
(206) 838-2585
Entity
Organization
Contact information
Practice address
1519 3RD ST SE STE 210, PUYALLUP, WA 98372-3742
(253) 840-4994
(253) 770-1105
Mailing address
1519 3RD ST SE STE 210, PUYALLUP, WA 98372-3742
(253) 840-4994
(253) 770-1105
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
601484763
WA
2086X0206X
Surgical Oncology Physician
601484763
WA
208800000X
Urology Physician
601484763
WA
208C00000X
Colon & Rectal Surgery Physician
601484763
WA
261QM1300X
Multi-Specialty Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0532700054
DME
WA
05
—
2042632
—
WA
01
—
338355
WA LABOR & INDUSTRIES
WA
Enumeration date
10/23/2014
Last updated
11/01/2022
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