Healthcare Provider Details

I. General information

NPI: 1215380126
Provider Name (Legal Business Name): GILLIAN J ZUCKERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GILLIAN CICALE GRIFFITH

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S 4TH AVE
YAKIMA WA
98902-3546
US

IV. Provider business mailing address

PO BOX 959
YAKIMA WA
98907-0959
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-4084
  • Fax: 509-225-6313
Mailing address:
  • Phone: 509-575-4084
  • Fax: 509-225-6313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61027432
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMD610
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: