MEDICARE: DR. GARY RICHARD SCHUSTER M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QS0010X	Sports Medicine (Family Medicine) Physician	MD0019545	WA
2	207R00000X	Internal Medicine Physician	MD0019545	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD0019545	OTHER	WA	WA STATE LICENSE

General Provider Information

NPI Number	:	1053500223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY RICHARD SCHUSTER M.D

Provider Business Mailing Address
First Line	:	1600 116TH AVE NE
Second Line	:	STE 202
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3056
Country	:	US
Telephone Number	:	206-215-8666
Fax Number	:	206-215-2289

Provider Business Practice Location Address
First Line	:	1600 116TH AVE NE
Second Line	:	STE 202
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3056
Country	:	US
Telephone Number	:	206-215-2288
Fax Number	:	206-215-2289

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	07/28/2025

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