Healthcare Provider Details

I. General information

NPI: 1346890944
Provider Name (Legal Business Name): GREGORY HANKS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10049 KITSAP MALL BLVD NW STE 109
SILVERDALE WA
98383-8901
US

IV. Provider business mailing address

10049 KITSAP MALL BLVD NW STE 109
SILVERDALE WA
98383-8901
US

V. Phone/Fax

Practice location:
  • Phone: 360-698-2505
  • Fax: 360-698-2514
Mailing address:
  • Phone: 360-698-2505
  • Fax: 360-698-2514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO61440975
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: