Healthcare Provider Details

I. General information

NPI: 1013032846
Provider Name (Legal Business Name): GARY PHILLIP CHIMES MD,PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 116TH AVE NE SUITE 206
BELLEVUE WA
98004-3014
US

IV. Provider business mailing address

1600 116TH AVE NE SUITE 206
BELLEVUE WA
98004-3014
US

V. Phone/Fax

Practice location:
  • Phone: 425-818-0558
  • Fax: 888-557-3062
Mailing address:
  • Phone: 425-818-0558
  • Fax: 888-557-3062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD434765
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number036-115660
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD60319630
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: