Healthcare Provider Details

I. General information

NPI: 1023073798
Provider Name (Legal Business Name): GYFT CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 SOUTH 19TH STREET STE #101
TACOMA WA
98405
US

IV. Provider business mailing address

PO BOX 8550
TACOMA WA
98419-0550
US

V. Phone/Fax

Practice location:
  • Phone: 255-475-5433
  • Fax: 253-473-6715
Mailing address:
  • Phone: 253-475-5433
  • Fax: 253-473-6715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT Z MCLEES
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 253-475-5433