Provider Demographics
NPI:1164535977
Name:FLEISCHHAUER, GERALD G (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:G
Last Name:FLEISCHHAUER
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 1:742 LEBO BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3325
Mailing Address - Country:US
Mailing Address - Phone:360-744-4950
Mailing Address - Fax:360-782-3540
Practice Address - Street 1:742 LEBO BLVD STE A
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3325
Practice Address - Country:US
Practice Address - Phone:360-744-4950
Practice Address - Fax:360-782-3540
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022938208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1003964Medicaid
WA8466641Medicaid
WAA15042Medicare UPIN