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NPI Code Detail

MEDICARE: DR. EDWARD M GACEK MD

MEDICARE: DR. EDWARD M GACEK MD
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
1208M00000XHospitalist PhysicianMD00022939WA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3110219614OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11110GAOTHERREGENCE BLUE SHIELD RIDER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679540793
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWARD M GACEK MD
Provider Business Mailing Address
First Line : 939 CAROLINE ST
Second Line :
City : PORT ANGELES
State : WA
Zip : 98362-3909
Country : US
Telephone Number : 360-417-7000
Fax Number :
Provider Business Practice Location Address
First Line : 939 CAROLINE ST
Second Line :
City : PORT ANGELES
State : WA
Zip : 98362-3909
Country : US
Telephone Number : 360-417-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2006
Last Update Date : 06/06/2012

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