Healthcare Provider Details

I. General information

NPI: 1689732588
Provider Name (Legal Business Name): HUGH JAMES GOREY JR. D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12001 PACIFIC AVE S. #204
TACOMA WA
98444-5101
US

IV. Provider business mailing address

12001 PACIFIC AVE S. #204
TACOMA WA
98444-5101
US

V. Phone/Fax

Practice location:
  • Phone: 253-531-5101
  • Fax: 253-536-7616
Mailing address:
  • Phone: 253-531-5101
  • Fax: 253-536-7616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO00000266
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: