Healthcare Provider Details

I. General information

NPI: 1538143292
Provider Name (Legal Business Name): STEVEN RANDALL GISS MD, FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11511 CANTERWOOD BLVD STE 140
GIG HARBOR WA
98332-5817
US

IV. Provider business mailing address

11511 CANTERWOOD BLVD STE 140
GIG HARBOR WA
98332-5817
US

V. Phone/Fax

Practice location:
  • Phone: 253-530-2940
  • Fax: 253-857-1489
Mailing address:
  • Phone: 253-530-2940
  • Fax: 253-857-1489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD22272
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD60891541
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: