Healthcare Provider Details

I. General information

NPI: 1790782209
Provider Name (Legal Business Name): JONATHAN W GRYMALOSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6884 HANNEGAN RD
EVERSON WA
98247-9637
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 360-354-0766
  • Fax: 360-357-7667
Mailing address:
  • Phone: 206-764-3335
  • Fax: 206-767-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD60051086
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60051086
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: