Provider Demographics
NPI:1831297258
Name:GORMLEY, JOANNE M (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:M
Last Name:GORMLEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7320 216TH ST SW STE 320
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8006
Mailing Address - Country:US
Mailing Address - Phone:425-673-3900
Mailing Address - Fax:425-693-3910
Practice Address - Street 1:7320 216TH ST SW STE 320B
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026
Practice Address - Country:US
Practice Address - Phone:425-775-6996
Practice Address - Fax:425-670-8905
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000433213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1045867Medicaid
WA1086883Medicaid
G17000140OtherMEDICARE
T86867Medicare UPIN
WA1054170OtherMEDICAID