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NPI Code Detail

MEDICARE: DR. ROY E GONDO M.D.

MEDICARE: DR. ROY E GONDO M.D.
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
1202K00000XPhlebology PhysicianMD00035498WA
2207Q00000XFamily Medicine PhysicianMD00035498WA

General Provider Information

NPI Number : 1669476131
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROY E GONDO M.D.
Provider Business Mailing Address
First Line : PO BOX 190
Second Line :
City : TOPPENISH
State : WA
Zip : 98948-0190
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 620 W 1ST ST
Second Line :
City : WAPATO
State : WA
Zip : 98951-1108
Country : US
Telephone Number : 509-877-4111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2005
Last Update Date : 11/26/2025

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