Healthcare Provider Details

I. General information

NPI: 1003094889
Provider Name (Legal Business Name): GREGORY RYAN LAMBERTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 3RD ST SE STE 210
PUYALLUP WA
98372-3724
US

IV. Provider business mailing address

805 MADISON ST SUITE 901
SEATTLE WA
98104-1172
US

V. Phone/Fax

Practice location:
  • Phone: 253-840-4994
  • Fax: 253-770-1105
Mailing address:
  • Phone: 206-264-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA90402
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD60101321
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: