Provider Demographics
NPI:1780899195
Name:GUSMAN, DENNIS N (DPM)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:N
Last Name:GUSMAN
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 1:202 N DIVISION ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-4939
Mailing Address - Country:US
Mailing Address - Phone:253-735-1478
Mailing Address - Fax:253-735-5061
Practice Address - Street 1:202 N DIVISION ST
Practice Address - Street 2:SUITE 302
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-4939
Practice Address - Country:US
Practice Address - Phone:253-735-1478
Practice Address - Fax:253-735-5061
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP000000393213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1052570Medicaid
WA000109489Medicare ID - Type Unspecified
T02030Medicare UPIN
WA1052570Medicaid