Provider Demographics
NPI:1245330059
Name:FELDMAN, GARY R (DDS MD PS)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:R
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:DDS MD PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 MADISON ST
Mailing Address - Street 2:SUITE 1116
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3588
Mailing Address - Country:US
Mailing Address - Phone:206-215-2088
Mailing Address - Fax:
Practice Address - Street 1:1221 MADISON ST
Practice Address - Street 2:SUITE 1116
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3588
Practice Address - Country:US
Practice Address - Phone:206-215-2088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000043381223S0112X
WAMD00017630204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery