Provider Demographics
NPI:1649335019
Name:GRABOWSKI, GREGORY JAMES (DPM)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JAMES
Last Name:GRABOWSKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11711 NE 12TH ST
Mailing Address - Street 2:SUITE 1-B
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2461
Mailing Address - Country:US
Mailing Address - Phone:425-453-1598
Mailing Address - Fax:425-450-0029
Practice Address - Street 1:11711 NE 12TH ST
Practice Address - Street 2:SUITE 1-B
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2461
Practice Address - Country:US
Practice Address - Phone:425-453-1598
Practice Address - Fax:425-450-0029
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000825213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8494890Medicaid
WA756480615OtherRAILROAD MEDICARE
WA0227707OtherL&I INSURANCE
WA8494890Medicaid