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Organization

PUYALLUP CLINIC INC

Active
Other names
Puyallup Clinic Inc., PS
Organization subpart
No

Provider details

NPI number
Authorized official
JERRY FRED DURIS MD (PRESIDENT AND CEO)
(253) 845-6645
Entity
Organization

Contact information

Practice address
800 S MERIDIAN STE A, PUYALLUP, WA 98371-6994
(253) 845-6645
(253) 770-2295
Mailing address
800 S MERIDIAN STE A, PUYALLUP, WA 98371-6994
(253) 845-6645
(253) 770-2295

Taxonomy

Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
261Q00000X
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7120363
WA
Enumeration date
03/28/2007
Last updated
07/31/2019
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