Provider Demographics
NPI:1386067809
Name:EMERGENCY PHYSICIANS OF GRAYS HARBOR
Entity type:Organization
Organization Name:EMERGENCY PHYSICIANS OF GRAYS HARBOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:360-637-9263
Mailing Address - Street 1:PO BOX 1898
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-0315
Mailing Address - Country:US
Mailing Address - Phone:360-637-9263
Mailing Address - Fax:360-637-8732
Practice Address - Street 1:1006 N H ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-2521
Practice Address - Country:US
Practice Address - Phone:360-537-6300
Practice Address - Fax:360-637-8732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000936207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty