Provider Demographics
NPI:1134488794
Name:JEFFERY, GARRETT SCOTT (DO)
Entity type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:SCOTT
Last Name:JEFFERY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1115 SE 164TH AVE DEPT 358
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8004
Mailing Address - Country:US
Mailing Address - Phone:360-729-1462
Mailing Address - Fax:360-729-3104
Practice Address - Street 1:11216 SUNRISE BLVD E
Practice Address - Street 2:# 3-106
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374
Practice Address - Country:US
Practice Address - Phone:253-848-5951
Practice Address - Fax:253-845-7073
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2018-05-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAOP60413252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2022097Medicaid
WAG8941840Medicare PIN