Healthcare Provider Details

I. General information

NPI: 1184677627
Provider Name (Legal Business Name): GARY LATHROP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17916 TALBOT RD S
RENTON WA
98055-7911
US

IV. Provider business mailing address

PO BOX 350
MAPLE VALLEY WA
98038-0350
US

V. Phone/Fax

Practice location:
  • Phone: 425-228-8880
  • Fax: 425-277-5812
Mailing address:
  • Phone: 425-358-0956
  • Fax: 877-481-6931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA00000366
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAS-P 195064
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: