Organization
PUYALLUP VALLEY PEDIATRIC ASSOCIATES, P.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY B JOLLEY M.D. (OWNER)
(253) 848-1572
Entity
Organization
Contact information
Practice address
1322 3RD ST SE, SUITE #240, PUYALLUP, WA 98372-3771
(253) 848-1572
(253) 841-3719
Mailing address
1322 3RD ST SE, SUITE #240, PUYALLUP, WA 98372-3771
(253) 848-1572
(253) 841-3719
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7142607
—
WA
Enumeration date
05/16/2007
Last updated
08/22/2020
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