| NPI | 1770723017 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Doing Business As | PMG BRIDGEPORT DERMATOLOGY |
| Entity Type | Organization |
| Authorized Contact | DONALD W ANDERSON Assistant Secretary Enrollment 425-358-9786 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2009-02-26 |
| Last Update Date | 2025-07-01 |