Provider Demographics
NPI:1689732588
Name:GOREY, HUGH JAMES JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:HUGH
Middle Name:JAMES
Last Name:GOREY
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12001 PACIFIC AVE S.
Mailing Address - Street 2:#204
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-5101
Mailing Address - Country:US
Mailing Address - Phone:253-531-5101
Mailing Address - Fax:253-536-7616
Practice Address - Street 1:12001 PACIFIC AVE S.
Practice Address - Street 2:#204
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-5101
Practice Address - Country:US
Practice Address - Phone:253-531-5101
Practice Address - Fax:253-536-7616
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000266213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT01613Medicare UPIN
WA8855959Medicare ID - Type Unspecified
WA5600090001Medicare NSC