| NPI | 1124325972 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Doing Business As | PROVIDENCE DYSPLASIA CLINIC |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Assistant Secretary Enrollments 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2011-02-14 |
| Last Update Date | 2024-09-04 |