Pacific Northwest Plastic Surgery, PS

Primary specialty

SpecialistTaxonomy code 174400000X

License

37332 Issued in WA

Legal business name

PACIFIC NORTHWEST PLASTIC SURGERY, PS

Practice address

5016 Bridgeport Way W
Suite a
University Place, WA 98467-2039

Phone

(253) 761-9515

Fax

(253) 761-1306

NPI assigned

Mar 20, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ross Maglaque Realica, MD

Title

President

Phone

(253) 761-9515

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326844800000",
    "number": "1205951910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5016 BRIDGEPORT WAY W",
            "address_2": "SUITE A",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984672039",
            "telephone_number": "253-761-9515",
            "fax_number": "253-761-1306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5016 BRIDGEPORT WAY W",
            "address_2": "SUITE A",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984672039",
            "telephone_number": "253-761-9515",
            "fax_number": "253-761-1306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC NORTHWEST PLASTIC SURGERY, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2012-01-18",
        "status": "A",
        "authorized_official_last_name": "REALICA",
        "authorized_official_first_name": "ROSS",
        "authorized_official_middle_name": "MAGLAQUE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "253-761-9515",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "WA",
            "license": "37332",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1107846",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in University Place, WA
• Providers in University Place, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.