Provider Demographics
NPI:1992812234
Name:GRUZENSKY, WILLIAM D (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:D
Last Name:GRUZENSKY
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:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:360-242-3008
Mailing Address - Fax:360-807-7687
Practice Address - Street 1:1600 A ST STE 200
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-5147
Practice Address - Country:US
Practice Address - Phone:907-272-2423
Practice Address - Fax:907-272-2428
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036987207W00000X
AKMEDS3011207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID180036475OtherRAIL ROAD MEDICARE
AK180037541OtherRAIL ROAD MEDICARE
OR1992812234Medicaid
NM50180070Medicaid
AK1012439Medicaid
WA180035935OtherRAIL ROAD MEDICARE
OR180041022OtherRAIL ROAD MEDICARE
MT180044160OtherRAIL ROAD MEDICARE
WA1024009Medicaid
ID180036476OtherRAIL ROAD MEDICARE
MT1992812234Medicaid
OR180041022OtherRAIL ROAD MEDICARE
WA180035936OtherRAIL ROAD MEDICARE
D86851Medicare UPIN
WAGAB08021Medicare PIN
ID1141355Medicare PIN
ID180036475OtherRAIL ROAD MEDICARE
WAGAB08023Medicare PIN
MT000082438Medicare PIN