Healthcare Provider Details

I. General information

NPI: 1720992514
Provider Name (Legal Business Name): GARY MATTHEW ARBUCKLE PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2078 VICTORIA AVE
PORT TOWNSEND WA
98368-7327
US

IV. Provider business mailing address

2078 VICTORIA AVE
PORT TOWNSEND WA
98368-7327
US

V. Phone/Fax

Practice location:
  • Phone: 203-988-4608
  • Fax:
Mailing address:
  • Phone: 203-988-4608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberPARA.ES.60429818
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: