NPIMap

Organization Active NPI

Puyallup Endocrine & Nuclear Medicine Clinics

  • Endocrinology, Diabetes & Metabolism Physician
  • Puyallup, WA
National Provider Identifier
1962525527
Registry record updated Jul 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
601891662 Issued in WA
Legal business name
PUYALLUP ENDOCRINE & NUCLEAR MEDICINE CLINICS
Practice address
1011 E Main Ave
Suite 302
Puyallup, WA 98372-6775
Phone
(253) 841-2471
Fax
(253) 841-2472
NPI assigned
Apr 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2014

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

Authorized official

Name
Dr. Donald F Devries, M.D.
Title
President
Phone
(253) 841-2471

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RE0101X 601891662 WA Primary
Nuclear Imaging & Therapy PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207UN0902X 601891662 WA

Addresses

Primary practice location

1011 E Main Ave
Suite 302
Puyallup, WA 98372-6775

Mailing address

1011 Main Ave E
Ste 302
Puyallup, WA 98372-6775
Phone (253) 841-2471

Other identifiers 3

IdentifierTypeStateIssuer
CI9058OtherRAILROAD MEDICARE
7093685MedicaidWA
113381OtherWALABOR & INDUSTRIES GROUP#

National Provider Directory

National Provider Directory

Locations

1011 E Main
Ste 302
Puyallup, WA 98372
Phone (253) 841-2471

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405987200000",
    "number": "1962525527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 MAIN AVE E",
            "address_2": "STE 302",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983726775",
            "telephone_number": "253-841-2471",
            "fax_number": "253-841-2472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 E MAIN AVE",
            "address_2": "SUITE 302",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983726775",
            "telephone_number": "253-841-2471",
            "fax_number": "253-841-2472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUYALLUP ENDOCRINE & NUCLEAR MEDICINE CLINICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2014-07-22",
        "status": "A",
        "authorized_official_last_name": "DEVRIES",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "253-841-2471",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "WA",
            "license": "601891662",
            "primary": true
        },
        {
            "code": "207UN0902X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nuclear Medicine, Nuclear Imaging & Therapy",
            "state": "WA",
            "license": "601891662",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CI9058",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7093685",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES GROUP#",
            "identifier": "113381",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2014; 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.