Provider Demographics
NPI:1275973398
Name:GUSS, LARK GREENWALD (MD)
Entity Type:Individual
Prefix:DR
First Name:LARK
Middle Name:GREENWALD
Last Name:GUSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LARK
Other - Middle Name:JULIE
Other - Last Name:GREENWALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 S COWLEY ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1332
Mailing Address - Country:US
Mailing Address - Phone:509-456-8444
Mailing Address - Fax:
Practice Address - Street 1:510 S COWLEY ST STE 200
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1332
Practice Address - Country:US
Practice Address - Phone:509-456-8444
Practice Address - Fax:509-455-9227
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT79073207N00000X, 207N00000X
WAMD60840220207ND0101X
CA148774207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology