Provider Demographics
NPI:1790825313
Name:HUGHES, GRADY M (MD)
Entity Type:Individual
Prefix:
First Name:GRADY
Middle Name:M
Last Name:HUGHES
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 1:1600 E JEFFERSON ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5698
Mailing Address - Country:US
Mailing Address - Phone:206-320-5686
Mailing Address - Fax:206-320-8145
Practice Address - Street 1:1600 E JEFFERSON ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5698
Practice Address - Country:US
Practice Address - Phone:206-320-5686
Practice Address - Fax:206-320-8145
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00023727207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA77260OtherLABOR & INDUSTRY
WA7064645Medicaid
WA1015361Medicaid
WA1117662Medicaid
WA1117662Medicaid