Provider Demographics
NPI:1760577688
Name:BLISS, GARRISON (MD)
Entity Type:Individual
Prefix:DR
First Name:GARRISON
Middle Name:
Last Name:BLISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 OLIVE WAY
Mailing Address - Street 2:SUITE 1607
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1720
Mailing Address - Country:US
Mailing Address - Phone:206-913-4700
Mailing Address - Fax:206-913-4710
Practice Address - Street 1:509 OLIVE WAY
Practice Address - Street 2:SUITE 1607
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1720
Practice Address - Country:US
Practice Address - Phone:206-913-4700
Practice Address - Fax:206-913-4710
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00016635207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1617406Medicaid
WA1617406Medicaid
000100498Medicare ID - Type Unspecified