Healthcare Provider Details

I. General information

NPI: 1710075825
Provider Name (Legal Business Name): FAMILY PRACTICE CENTER OF GRAYS HARBOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 K ST
HOQUIAM WA
98550-3705
US

IV. Provider business mailing address

815 K ST
HOQUIAM WA
98550-3705
US

V. Phone/Fax

Practice location:
  • Phone: 360-538-1609
  • Fax: 360-533-7107
Mailing address:
  • Phone: 360-538-1609
  • Fax: 360-533-7107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANET K JULL
Title or Position: OFFICE MANAGER
Credential:
Phone: 360-538-1609