Organization
PARADISE WOUND HEALING PROFESSIONALS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALEX C TOWN (CFO)
(509) 758-4667
Entity
Organization
Contact information
Practice address
1119 HIGHLAND AVENUE, SUITE 7, CLARKSTON, WA 99403-2836
(509) 758-1119
(509) 758-1140
Mailing address
PO BOX 189, CLARKSTON, WA 99403-0189
(509) 758-1119
(509) 758-1140
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
602411261
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DJVB5
BLUE CROSS OF IDAHO
—
Enumeration date
03/22/2007
Last updated
03/20/2012
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