Provider Demographics
NPI:1417918160
Name:GRIES, DELORES MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:DELORES
Middle Name:MARY
Last Name:GRIES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9040 REID ST # A
Mailing Address - Street 2:MADIGAN ARMY MEDICAL CENTER, ATTN: MCHJ-QCR
Mailing Address - City:JOINT BASE LEWIS MCCHORD
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-1221
Mailing Address - Fax:253-968-1222
Practice Address - Street 1:9040 READ ST
Practice Address - Street 2:MADIGAN ARMY MEDICAL CENTER, ATTN: MCHJ-QCR
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-1221
Practice Address - Fax:253-968-1222
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36205-020171000000X
WAMD604566802080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No171000000XOther Service ProvidersMilitary Health Care Provider