Basic Information
| Provider Information | |||||||||
| NPI: | 1538275763 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAR NOSE AND THROAT ASSOCIATES PS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1005 W WALNUT ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095751000 | ||||||||
| FaxNumber: | 5075751197 | ||||||||
| Practice Location | |||||||||
| Address1: | 1005 W WALNUT ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095751000 | ||||||||
| FaxNumber: | 5075751197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 10/30/2007 | ||||||||
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| AuthorizedOfficialLastName: | MARTIN | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5095751000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.