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Individual

MARY LOUISE GRODA-LEWIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1322 3RD ST SE, STE 240, PUYALLUP, WA 98372-3771
(253) 697-5757
Mailing address
1322 3RD ST SE, STE 240, PUYALLUP, WA 98372-3771
(253) 697-5757

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
38085
IA
207Q00000X
Family Medicine Physician
Primary
MD00038716
WA
207V00000X
Obstetrics & Gynecology Physician
MD00038716
WA
208D00000X
General Practice Physician
MD00038716
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P00677919
RR MEDICARE
IA
Enumeration date
05/20/2006
Last updated
11/01/2013
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