Provider Demographics
NPI:1962487892
Name:PINGREY, GARY RICHARD (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:RICHARD
Last Name:PINGREY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4700 POINT FOSDICK DR NW
Mailing Address - Street 2:#220
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1706
Mailing Address - Country:US
Mailing Address - Phone:253-851-5121
Mailing Address - Fax:253-851-3059
Practice Address - Street 1:4700 POINT FOSDICK DR NW
Practice Address - Street 2:#220
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1706
Practice Address - Country:US
Practice Address - Phone:253-851-5121
Practice Address - Fax:253-851-3059
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA001003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0291717OtherSTATE L&I
WA0291790OtherSTATE L&I
WA8304073Medicaid
P05753OtherREGENCE
WA3111OtherL & I
WA0291790OtherSTATE L&I
1047102Medicare ID - Type Unspecified
WAG8907301Medicare PIN