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General NPI Number Information
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NPI Number | 1417918160
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Entity Type | Individual
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Provider Name | DELORES MARY GRIES MD
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Gender | Female
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 04/13/2015
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Provider Practice Location Address
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Address Line | 9040 READ ST MADIGAN ARMY MEDICAL CENTER, ATTN: MCHJ-QCR
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City | TACOMA
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State | WA
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Zip | 98431-0001
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Country | US
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Telephone | 253-968-1221
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Fax | 253-968-1222
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Provider Business Mailing Address
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Address Line | 9040 REID ST # A MADIGAN ARMY MEDICAL CENTER, ATTN: MCHJ-QCR
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City | JOINT BASE LEWIS MCCHORD
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State | WA
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Zip | 98431-0001
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Country | US
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Telephone | 253-968-1221
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Fax | 253-968-1222
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 36205-020
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | MD60456680
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License Number State | WA
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