Healthcare Provider Details

I. General information

NPI: 1497195762
Provider Name (Legal Business Name): ZACHARY DAVID GUSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 W 5TH AVE STE 102B
SPOKANE WA
99204-2948
US

IV. Provider business mailing address

910 W 5TH AVE STE 102B
SPOKANE WA
99204-2948
US

V. Phone/Fax

Practice location:
  • Phone: 509-755-5783
  • Fax: 509-459-1522
Mailing address:
  • Phone: 509-755-5783
  • Fax: 509-459-1522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD00017033
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: