Organization
PROLIANCE SURGEONS, INC., P.S.
Active
Organization
PROLIANCE SURGEONS, INC., P.S.
Active
Other names
Northwest Orthopaedic and Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID G. FITZGERALD (CEO)
(206) 838-2599
Entity
Organization
Contact information
Practice address
875 SWIFT BLVD, RICHLAND, WA 99352-3592
(509) 946-1654
(509) 943-5652
Mailing address
805 MADISON ST, SUITE 901, SEATTLE, WA 98104-1172
(206) 264-8100
(206) 264-8689
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0287402
L & I
WA
Enumeration date
11/10/2011
Last updated
12/09/2011
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