MEDICARE: JONATHAN W GRYMALOSKI 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	207V00000X	Obstetrics & Gynecology Physician	MD60051086	WA
2	207Q00000X	Family Medicine Physician	MD60051086	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790782209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN W GRYMALOSKI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 34703
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-1703
Country	:	US
Telephone Number	:	206-764-3335
Fax Number	:	206-767-0489

Provider Business Practice Location Address
First Line	:	6884 HANNEGAN RD
Second Line	:
City	:	EVERSON
State	:	WA
Zip	:	98247-9637
Country	:	US
Telephone Number	:	360-354-0766
Fax Number	:	360-357-7667

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	05/30/2024

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