Individual
DR. GARY LEE FILLMORE
Active
Individual
DR. GARY LEE FILLMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MD00049255
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0239190
DEPT OF LABOR AND INDUSTRIES
WA
05
—
808422000
—
ID
05
—
8509440
—
WA
01
—
8949273
CRIME VICTIMS' COMPENSATION
WA
01
—
G8874801
MEDICARE PTAN
WA
01
—
MD00049255
PHYSICIAN AND SURGEON LICENSE
WA
01
—
P00642793
RAILROAD MEDICARE
—
Enumeration date
11/10/2005
Last updated
03/07/2023
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