Provider Demographics
NPI:1649733254
Name:GHANBARI, GILAD MIZRAHI (DO)
Entity type:Individual
Prefix:
First Name:GILAD
Middle Name:MIZRAHI
Last Name:GHANBARI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 SENECA ST
Mailing Address - Street 2:MAIL STOP: H8-GME
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2742
Mailing Address - Country:US
Mailing Address - Phone:206-583-6079
Mailing Address - Fax:203-713-9066
Practice Address - Street 1:925 SENECA STREET
Practice Address - Street 2:MAIL STOP: H8-GME
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101
Practice Address - Country:US
Practice Address - Phone:206-583-6079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307681208D00000X
390200000X
WAOP61079628208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program