Individual
MR. GARRY GREGORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
10004 204TH AVE E, #1200, BONNEY LAKE, WA 98391-6539
(253) 848-5951
(253) 845-7073
Mailing address
3908 10TH ST SE, PUYALLUP, WA 98374-2188
(253) 848-5951
(253) 845-7073
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10004445
WA
363AM0700X
Medical Physician Assistant
PA1000445
WA
363AS0400X
Surgical Physician Assistant
PA1000445
WA
Other
Enumeration date
01/23/2007
Last updated
01/25/2016
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