Provider Demographics
NPI:1780657775
Name:DRY, GAVIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:M
Last Name:DRY
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 1:13114 120TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3014
Mailing Address - Country:US
Mailing Address - Phone:425-821-6000
Mailing Address - Fax:425-820-6288
Practice Address - Street 1:13114 120TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3014
Practice Address - Country:US
Practice Address - Phone:425-821-6000
Practice Address - Fax:425-820-6288
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035648208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1112622Medicaid
WA3230OtherREGENCE BLUE SHIELD
WA151770OtherL&I
WAGAB22070Medicare ID - Type Unspecified
H37478Medicare UPIN