Provider Demographics
NPI:1295772291
Name:ZEIGLER, GARY MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:MICHAEL
Last Name:ZEIGLER
Suffix:
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 1:505 S 336TH STREET
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6328
Mailing Address - Country:US
Mailing Address - Phone:253-838-6180
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:1601 SE COURT AVENUE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3217
Practice Address - Country:US
Practice Address - Phone:541-276-5121
Practice Address - Fax:541-278-3661
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23743207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR8350670Medicaid
OR041428009OtherBSOR
OR286641Medicaid
ORP00388292Medicare PIN
ORH64495Medicare UPIN
ORR131324Medicare PIN