| Vashon Plaza Medical Clinic | |
|
17639 100th Ave Sw Vashon WA 98070-5234 | |
| (206) 463-3696 | |
| Not Available |
| Full Name | Vashon Plaza Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 17639 100th Ave Sw, Vashon, Washington |
| Authorized Official Name and Position | Gail Lynn Fulton (PHYSICIAN OWNER) |
| Authorized Official Contact | 2064633696 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vashon Plaza Medical Clinic Po Box N Vashon WA 98070-0360 Ph: (206) 463-3696 | Vashon Plaza Medical Clinic 17639 100th Ave Sw Vashon WA 98070-5234 Ph: (206) 463-3696 |
| NPI Number | 1629352984 |
|---|---|
| Provider Enumeration Date | 10/05/2011 |
| Last Update Date | 01/11/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629352984 | NPI | - | NPPES |
| 8126757 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD00027813 (Washington) | Primary |
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