MEDICARE: DR. JONATHAN GIFFORD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MD60235501	WA

General Provider Information

NPI Number	:	1477681583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN GIFFORD MD

Provider Business Mailing Address
First Line	:	1006 N H ST FL 5
Second Line	:
City	:	ABERDEEN
State	:	WA
Zip	:	98520-2521
Country	:	US
Telephone Number	:	360-537-6414
Fax Number	:	360-532-6878

Provider Business Practice Location Address
First Line	:	1006 N H ST FL 5
Second Line	:
City	:	ABERDEEN
State	:	WA
Zip	:	98520-2521
Country	:	US
Telephone Number	:	360-537-6414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/29/2021

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