Provider Demographics
NPI:1275564742
Name:RIES, GERALD EDWARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:EDWARD
Last Name:RIES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 N 38TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-5618
Mailing Address - Country:US
Mailing Address - Phone:253-752-4753
Mailing Address - Fax:253-593-3311
Practice Address - Street 1:1 BOONE RD
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-1894
Practice Address - Country:US
Practice Address - Phone:360-475-4586
Practice Address - Fax:360-475-5016
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032547207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARI1447OtherREGENCE
WA64434OtherLABOR & INDUSTIES
WA8180556Medicaid
WAG00847Medicare UPIN
WA001054312Medicare ID - Type Unspecified