Southlake Select, PC

NPI #1548791924 in Renton, Washington

Provider Information

NPI Number: 1548791924
Entity Type: Organization
Organization Name: Southlake Select, PC
Primary Specialty: Internal Medicine
Enumeration Date: Mar 27, 2017
Last Updated: May 8, 2017

Practice Location

Address: 4011 TALBOT RD S
Address 2: 440
City: Renton
State: Washington
ZIP Code: 98055-5773
Phone: (425) 793-4702

Authorized Official

Name: DR. DOMINICK ROBERT TOULOUSE, M.D.
Title: PRESIDENT
Phone: (425) 793-4702

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Point of Service	305S00000X
Internal Medicine	207R00000X	Primary

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