Provider Demographics
NPI:1407836471
Name:GRESCH, ELIZABETH EVANS (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:EVANS
Last Name:GRESCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2630 77TH AVE SE UNIT 420
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-4055
Mailing Address - Country:US
Mailing Address - Phone:206-300-6228
Mailing Address - Fax:206-232-2444
Practice Address - Street 1:2630 77TH AVE SE UNIT 420
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-4055
Practice Address - Country:US
Practice Address - Phone:206-300-6228
Practice Address - Fax:206-232-2444
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000356702083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine