Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | 036-115660 | IL |
N | 213ES0000X | Sports Medicine | 036-115660 | IL |
N | 2081S0010X | Sports Medicine | MD434765 | PA |
N | 213ES0000X | Sports Medicine | MD434765 | PA |
Y | 2081S0010X | Sports Medicine | MD60319630 | WA |
Y | 213ES0000X | Sports Medicine | MD60319630 | WA |
NPI | 1013032846 |
---|---|
Provider Name | Dr. Gary Phillip Chimes |
First Address | Bellevue, WA 98004-3014 |
Second Address | Bellevue, WA 98004-3014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 19/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07080018400 | QUALCHOICE (01) | AR |
165028001 | (05) | AR |
5N905 | BCBS (01) | AR |
E5236 | ARKANSAS MEDICAL LICENSE (01) | AR |
P00401878 | RAILROAD MEDICARE (01) | AR |