Provider Demographics
NPI:1972706422
Name:WEISSENFLUH, GARY MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:MICHAEL
Last Name:WEISSENFLUH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PASTEUR DR # H3691
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-3635
Practice Address - Country:US
Practice Address - Phone:360-678-6799
Practice Address - Fax:360-678-6654
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATO61436240208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty