Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QS0010X | Family Doctor - Sports Medicine | MD0019545 | WA |
Y | 207R00000X | Internist | MD0019545 | WA |
Y | 111NI0900X | Internist | MD0019545 | WA |
NPI | 1053500223 |
---|---|
Provider Name | Dr. Gary Richard Schuster |
First Address | Bellevue, WA 98004-3056 |
Second Address | Bellevue, WA 98004-3056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2007 |
Last Update Date | 04/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A05585 | (02) | WA |
MD0019545 | WA STATE LICENSE (01) | WA |