Individual
GEORGE A PRUDDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7308 BRIDGEPORT WAY W, SUITE 201, LAKEWOOD, WA 98499-8000
(253) 582-7257
(253) 582-1617
Mailing address
9084 SE WILLOCK RD STE 201, OLALLA, WA 98359-9660
(253) 576-7353
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10004097
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6882PR
REGENCE BLUE SHIELD RIDER
WA
05
—
8348963
—
WA
Enumeration date
03/15/2006
Last updated
10/01/2019
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