Individual
GARY KELSBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3915 TALBOT RD S, STE 401, RENTON, WA 98055-5738
(425) 656-4224
Mailing address
3600 LIND AVE SW, SUITE 100 ATTN CREDENTIALING, RENTON, WA 98057
(425) 690-2715
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00020020
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1018969
—
WA
05
—
8552408
—
WA
01
—
G8891876
MEDICARE W VALLEY MEDICAL GROUP - RENTON
WA
Enumeration date
07/24/2006
Last updated
03/10/2020
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