Healthcare Provider Details

I. General information

NPI: 1053500223
Provider Name (Legal Business Name): GARY RICHARD SCHUSTER M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 116TH AVE NE STE 202
BELLEVUE WA
98004-3056
US

IV. Provider business mailing address

1600 116TH AVE NE STE 202
BELLEVUE WA
98004-3056
US

V. Phone/Fax

Practice location:
  • Phone: 206-215-2288
  • Fax: 206-215-2289
Mailing address:
  • Phone: 206-215-8666
  • Fax: 206-215-2289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD0019545
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD0019545
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: