Healthcare Provider Details

I. General information

NPI: 1265494546
Provider Name (Legal Business Name): GARY DOOLITTLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 CAPITAL MALL DR SW
OLYMPIA WA
98502-8654
US

IV. Provider business mailing address

PO BOX 94525
SEATTLE WA
98124-6825
US

V. Phone/Fax

Practice location:
  • Phone: 360-709-6230
  • Fax:
Mailing address:
  • Phone: 425-407-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number29151
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: