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General NPI Number Information
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NPI Number | 1376617159
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Entity Type | Individual
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Provider Name | DAVID GILLINGHAM D.O.
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 1620 COOPER POINT ROAD NW PMG SW WA W OLYMPIA FAM MED
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City | OLYMPIA
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State | WA
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Zip | 98502
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Country | US
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Telephone | 360-486-6710
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Fax | 360-956-1643
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Provider Business Mailing Address
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Address Line | PO BOX 3360
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City | PORTLAND
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State | OR
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Zip | 97208-3360
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Country | US
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Telephone | 360-486-6508
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OP00001138
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License Number State | WA
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