Organization
SOUTHLAKE SELECT, PC
Active
Organization
SOUTHLAKE SELECT, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOMINICK ROBERT TOULOUSE M.D. (PRESIDENT)
(425) 793-4702
Entity
Organization
Contact information
Practice address
4011 TALBOT RD S, 440, RENTON, WA 98055-5773
(425) 793-4702
(425) 271-5382
Mailing address
4011 TALBOT RD S, 440, RENTON, WA 98055-5773
(425) 793-4702
(425) 271-5382
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
305S00000X
Point of Service
0020685
WA
Other
Enumeration date
03/27/2017
Last updated
05/08/2017
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