Healthcare Provider Details

I. General information

NPI: 1851088793
Provider Name (Legal Business Name): GRACIE RUBIDEAUX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 COOPER POINT RD SW
OLYMPIA WA
98502-5736
US

IV. Provider business mailing address

1620 COOPER POINT RD SW
OLYMPIA WA
98502-5736
US

V. Phone/Fax

Practice location:
  • Phone: 360-486-6710
  • Fax: 360-705-0269
Mailing address:
  • Phone: 360-486-6710
  • Fax: 360-705-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.MD.70130985
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: