Puyallup Dermatology Clinic Inc P.S.

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD00038522 Issued in WA

Legal business name

PUYALLUP DERMATOLOGY CLINIC INC P.S.

Practice address

2622 S Meridian
Puyallup, WA 98373-1500

Phone

(253) 841-2453

Fax

(253) 840-5519

NPI assigned

Aug 3, 2005

Last updated

Jun 2, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jason Meeker, M.D.NPI 1871835322

Title

Owner

Phone

(253) 841-2453

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jason Lee Meeker, MD

  • Dermatology Physician
  • Puyallup, WA
  • NPI 1871835322
  Medicare reassignment Care Compare group Authorized official
• Marina Viktorovna Dolmatova, ARNP

  • Family Nurse Practitioner
  • Puyallup, WA
  • NPI 1043865421
  Medicare reassignment Care Compare group NPD
• Elizaveta Hermann

  • Physician Assistant
  • Issaquah, WA
  • NPI 1124321419
  Medicare reassignment Care Compare group
• Jeffrey Stephen Newman, M.D., PHD

  • Procedural Dermatology Physician
  • Puyallup, WA
  • NPI 1528032919
  Medicare reassignment Care Compare group
• Aaron Kimball Rasmussen, PA

  • Medical Physician Assistant
  • Puyallup, WA
  • NPI 1316258767
  Medicare reassignment Care Compare group
• Dan Algot Wiklund, M.D.

  • Procedural Dermatology Physician
  • Puyallup, WA
  • NPI 1386645976
  NPD

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

{
    "created_epoch": "1123027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748822400000",
    "number": "1740281344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "929 E MAIN AVE",
            "address_2": "SUITE 210",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723116",
            "telephone_number": "253-841-2453",
            "fax_number": "253-840-5519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2622 S MERIDIAN",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983731500",
            "telephone_number": "253-841-2453",
            "fax_number": "253-840-5519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUYALLUP DERMATOLOGY CLINIC INC P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-03",
        "last_updated": "2025-06-02",
        "certification_date": "2025-06-02",
        "status": "A",
        "authorized_official_last_name": "MEEKER",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-841-2453",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "MD00038522",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7095656",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF L&I",
            "identifier": "53030",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Puyallup Ambulatory Surgery Center, LLC
• Puyallup Care Center, Inc (Regency at Puyallup Rehabilitation Center)
• Puyallup Children's Clinic, PLLC
• Puyallup Clinic Inc
• Puyallup Dental, LLC
• Puyallup Endocrine & Nuclear Medicine Clinics
• Puyallup Imaging Consultants LLC
• Puyallup Loving Arms Afh LLC
• Puyallup Open Imaging LLC
• Puyallup Park Dental

• Specialist in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.