Organization
PROLIANCE SURGEONS, INC., P.S.
Active
Other names
Orthopedic Specialists/Valley Sports Medicine of POA
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID G. FITZGERALD (CEO)
(206) 838-2599
Entity
Organization
Contact information
Practice address
4361 TALBOT RD S, SUITE 102, RENTON, WA 98055-6226
(425) 226-1180
(425) 235-0695
Mailing address
805 MADISON ST, SUITE 901, SEATTLE, WA 98104-1172
(206) 264-8100
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
601484763
WA
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
601484763
WA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
601484763
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GAB03033
MEDICARE PTAN
WA
Enumeration date
06/05/2014
Last updated
06/05/2014
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