Provider Demographics
NPI:1205019213
Name:HENRI PAUL GABORIAU, M.D., PC
Entity Type:Organization
Organization Name:HENRI PAUL GABORIAU, M.D., PC
Other - Org Name:SAMMAMISH CENTER FOR FACIAL PLASTIC & RECONSTRUCTIVE SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRI
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GABORIAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-898-1228
Mailing Address - Street 1:22840 NE 8TH ST
Mailing Address - Street 2:SUITE #103
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-7262
Mailing Address - Country:US
Mailing Address - Phone:425-898-1228
Mailing Address - Fax:425-898-0279
Practice Address - Street 1:22840 NE 8TH ST
Practice Address - Street 2:SUITE #103
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7262
Practice Address - Country:US
Practice Address - Phone:425-898-1228
Practice Address - Fax:425-898-0279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037350174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG90321Medicare UPIN
WAGAB25912Medicare PIN