Provider Demographics
NPI:1922055656
Name:GAVARESKI, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:GAVARESKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:709 W ORCHARD DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1766
Mailing Address - Country:US
Mailing Address - Phone:360-318-8800
Mailing Address - Fax:360-318-1085
Practice Address - Street 1:3500 ORCHARD PL
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1749
Practice Address - Country:US
Practice Address - Phone:360-671-3900
Practice Address - Fax:360-647-0882
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2012-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00014503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1037902Medicaid
WA0130082OtherLABOR & INDUSTRIES (REG)
WA14750OtherREGENCE BLUESHIELD
WA423898021OtherGROUP HEALTH COOPERATIVE
WA080148056OtherRAILROAD MEDICARE
WA8925067OtherLABOR & INDUSTRIES (CV)
WAGAB08996Medicare PIN
WA1037902Medicaid