Provider Demographics
NPI:1003042797
Name:FUGATE, RYAN MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MATTHEW
Last Name:FUGATE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 SE 24TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2300
Mailing Address - Country:US
Mailing Address - Phone:206-230-0330
Mailing Address - Fax:206-230-0336
Practice Address - Street 1:7525 SE 24TH ST STE 400
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2300
Practice Address - Country:US
Practice Address - Phone:206-230-0330
Practice Address - Fax:206-230-0336
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD606990342084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry