Provider Demographics
NPI:1891897286
Name:THUOT, GAYLE E (MD)
Entity Type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:E
Last Name:THUOT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13451 SE 36TH
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006
Mailing Address - Country:US
Mailing Address - Phone:425-562-1332
Mailing Address - Fax:425-562-1445
Practice Address - Street 1:13451 SE 36TH
Practice Address - Street 2:GROUP HEALTH COOPERATIVE FACTORIA CLINIC
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006
Practice Address - Country:US
Practice Address - Phone:425-562-1332
Practice Address - Fax:425-562-1445
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014375208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8413601Medicaid
A05795Medicare UPIN