| NPI | 1679678866 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Doing Business As | PROVIDENCE MEDICAL GROUP SOUTHEAST FAMILY MEDICINE |
| Entity Type | Organization |
| Authorized Contact | DONALD W ANDERSON Asst Sec Enroll 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 103T00000X Psychologist |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2024-06-13 |