Individual
H GARY CORLESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
7315 212TH ST SW, #103, EDMONDS, WA 98026
(425) 775-6996
(425) 670-8905
Mailing address
PO BOX 11009, OLYMPIA, WA 98508-1009
(425) 775-6996
(425) 670-8905
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
PO00000139
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0164994
L AND I
—
05
—
1183409
—
WA
01
—
5182CO
REGENCE RIDER
WA
01
—
9050600
MEDICAID/DMERC
WA
Enumeration date
11/02/2006
Last updated
01/10/2008
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