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General NPI Number Information
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NPI Number | 1265413769
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Entity Type | Individual
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Provider Name | GARY LEE FILLMORE M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 9911 N NEVADA ST STE B
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City | SPOKANE
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State | WA
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Zip | 99218
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Country | US
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Telephone | 509-484-5710
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Fax | 509-487-1000
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Provider Business Mailing Address
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Address Line | 9911 N NEVADA ST STE B
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City | SPOKANE
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State | WA
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Zip | 99218-1298
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Country | US
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Telephone | 509-484-5710
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Fax | 509-487-1000
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD00049255
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License Number State | WA
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