Provider Demographics
NPI:1023073798
Name:GYFT CLINIC, PLLC
Entity type:Organization
Organization Name:GYFT CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MCLEES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-475-5433
Mailing Address - Street 1:PO BOX 8550
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98419-0550
Mailing Address - Country:US
Mailing Address - Phone:253-475-5433
Mailing Address - Fax:253-473-6715
Practice Address - Street 1:2201 SOUTH 19TH STREET
Practice Address - Street 2:STE #101
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:255-475-5433
Practice Address - Fax:253-473-6715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7020613Medicaid