NPI 1205164639

Maranatha Medical Clinic INC P S

Organisation Internal Medicine Physician Renton, WA

Practice location

Address: 17900 Talbot Rd S #101, Renton, WA 98055-8212
Phone: (425) 235-9614
Fax: (425) 235-1060

Authorised official

Name: Dan L Grav Es
Title: President
Phone: (425) 235-9614

Registered specialties

Internal Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207R00000X Licence 17917 (WA)

Other Internal Medicine providers in Washington →

Registry record

NPI: 1205164639
Entity type: Organization
NPI issued: 23 Nov 2009
Record last updated: 11 Sep 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.