Healthcare Provider Details

I. General information

NPI: 1871582833
Provider Name (Legal Business Name): GARY M. BELCASTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7425 WRIGLEY DR STE 204
PASCO WA
99301
US

IV. Provider business mailing address

520 N 4TH AVE
PASCO WA
99301-5257
US

V. Phone/Fax

Practice location:
  • Phone: 509-416-8885
  • Fax:
Mailing address:
  • Phone: 509-416-8882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD00041984
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: