| NPI | 1790107050 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Doing Business As | PROVIDENCE MEDICAL GROUP GLISAN DERMATOLOGY AT SUNNYSIDE |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Asst Sec Enrollment 425-358-9786 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2014-01-06 |
| Last Update Date | 2025-07-01 |