Provider Demographics
NPI:1053500223
Name:SCHUSTER, GARY RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:RICHARD
Last Name:SCHUSTER
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 1:1600 116TH AVE NE
Mailing Address - Street 2:STE 202
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3056
Mailing Address - Country:US
Mailing Address - Phone:206-215-8666
Mailing Address - Fax:206-215-2289
Practice Address - Street 1:1600 116TH AVE NE
Practice Address - Street 2:STE 202
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3056
Practice Address - Country:US
Practice Address - Phone:206-215-2288
Practice Address - Fax:206-215-2289
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD0019545207QS0010X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD0019545OtherWA STATE LICENSE
WAG8898923Medicare PIN
WAMD0019545OtherWA STATE LICENSE