Provider Demographics
NPI:1972535763
Name:SAUE, GREGORY LEE (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:LEE
Last Name:SAUE
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 1:14114 SHOREVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:MEDICAL LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99022-9345
Mailing Address - Country:US
Mailing Address - Phone:509-299-7771
Mailing Address - Fax:
Practice Address - Street 1:MAPLE STREET
Practice Address - Street 2:
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022-0800
Practice Address - Country:US
Practice Address - Phone:509-299-4529
Practice Address - Fax:509-299-4649
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA16399207RR0500X
WAMD00016399208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1091289Medicaid
319000125Medicare ID - Type Unspecified
WI501895Medicare Oscar/Certification
WA1091289Medicaid