Healthcare Provider Details

I. General information

NPI: 1396735437
Provider Name (Legal Business Name): GARY LEE SCHILLHAMMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 RIDDLE ST
DARRINGTON WA
98241
US

IV. Provider business mailing address

PO BOX 309
DARRINGTON WA
98241-0309
US

V. Phone/Fax

Practice location:
  • Phone: 360-436-1055
  • Fax: 360-436-0146
Mailing address:
  • Phone: 360-436-1055
  • Fax: 360-436-0146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00021477
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: