Healthcare Provider Details

I. General information

NPI: 1083762546
Provider Name (Legal Business Name): LOUIS GEVIRTZMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 WEDGEWOOD CT SE
OLYMPIA WA
98501-3855
US

IV. Provider business mailing address

2540 WEDGEWOOD CT SE
OLYMPIA WA
98501-3855
US

V. Phone/Fax

Practice location:
  • Phone: 360-352-7373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number28429
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: