DR. GARY FUDEM (NPI# 1336123454) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336123454 |
| Entity Type | Individual |
| Full Name | DR. GARY FUDEM |
| Credential | M.D. |
| Practice Address |
325 9th Ave Department of Plastic & Reconstructive Surgery Seattle WA 98104-2420 |
| Mailing Address |
Po Box 50095 Seattle WA 98145-5095 |
| Practice Telephone | 2067445735 |
| Mailing Telephone | 2065436420 |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2014-12-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
MD60484351 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 1336123454 | 05 |
| Street Address |
325 9TH AVE DEPARTMENT OF PLASTIC & RECONSTRUCTIVE SURGERY |
| City | SEATTLE |
| State | WA |
| Zip Code | 98104-2420 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851395743 | Judith Kay Glann | Nurse Practitioner | 325 9th Ave, Seattle, WA 98104-2420 | 2005-06-08 |
| 1720688427 | Angelo John Jamora | Advanced Practice Midwife | 325 9th Ave, Seattle, WA 98104-2420 | 2020-10-30 |
| 1174123939 | Kaitlin C Fitzgerald | Physician Assistant | 325 9th Ave, Seattle, WA 98104-2420 | 2020-10-29 |
| 1184222739 | Kristi Griffing | Registered Nurse | 325 9th Ave, Seattle, WA 98104-2499 | 2020-10-15 |
| 1558968925 | Maeve Muldowney | Anesthesiology | 325 9th Ave, Seattle, WA 98104-2420 | 2020-10-07 |
| 1073128203 | Allison Engstrom | Social Worker | 325 9th Ave, Seattle, WA 98104-2499 | 2020-09-14 |
| 1376158501 | Vallie Jacobson | Registered Nurse | 325 9th Ave, Seattle, WA 98104-2420 | 2020-09-14 |
| 1801401187 | Leigh Anne Kalaman | Registered Nurse | 325 9th Ave, Seattle, WA 98104-2499 | 2020-09-13 |
| 1114532496 | Shayna Erickson | Pharmacist | 325 9th Ave, Seattle, WA 98104-2420 | 2020-09-13 |
| 1144834698 | Tonya L Webb | Registered Nurse | 325 9th Ave, Seattle, WA 98104-2420 | 2020-09-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699394312 | Richard Charles Harruff | Pathology | King County Medical Examiners Office, 325 Ninth Avenue, Seattle, WA 98104 | 2020-04-13 |
| 1558999474 | Nathan Richard Benner | Student in an Organized Health Care Education/Training Program | Uw Medicine-harborview Medical Center Orthopaedics, 325 Ninth Avenue, Seattle, WA 98104 | 2020-03-27 |
| 1063058493 | Brook, LLC. | Health Educator | 311 1/2 Occidental Ave South, Suite 210, Seattle, WA 98104 | 2019-11-20 |
| 1609418813 | Stephanie Amanda Ann Mason | Student in an Organized Health Care Education/Training Program | 325 9th Avenue, Mail Stop #359796, Seattle, WA 98104 | 2019-10-09 |
| 1013480250 | Robert Kenneth Lozier | Pedorthist | Norm Maleng Building, 410 9th Ave, 4th Floor, Seattle, WA 98104 | 2019-01-10 |
| 1548739576 | Lee Hanses | Physical Therapist | 1124 Columbia Street, Level P1, Suite P100, Seattle, WA 98104 | 2018-11-20 |
| 1821579095 | Karissa Lin Lee | Pharmacist | 401 Broadway #2075, Seattle, WA 98104 | 2018-08-27 |
| 1477042091 | Maham Jehangir | Student in an Organized Health Care Education/Training Program | 325 9th Ave Department of Radiology, Seattle, WA 98104 | 2018-05-09 |
| 1740786581 | Philip Daniel Tolley | Student in an Organized Health Care Education/Training Program | 325 9th Ave. Mail Stop#359796, 7th Floor Center Tower Rm #73.1, Seattle, WA 98104 | 2018-04-02 |
| 1528564242 | Vanessa Dawn Leonhard | Student in an Organized Health Care Education/Training Program | 325 9th Ave, 7th Floor Center Tower Room 73.1, Mail Stop #359796, Seattle, WA 98104 | 2018-04-02 |
| Find all providers in zip 98104 | ||||
| Taxonomy Code | 2086S0122X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Plastic and Reconstructive Surgery |
| A surgeon who specializes in plastic and reconstructive surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821154790 | Alexander Gougoutas | Surgery | 1560 N 115th St Ste 206, Seattle, WA 98133-8414 | 2006-12-28 |
| 1699337865 | Mert Calis | Surgery | 4800 Sand Point Way Ne, O.b.9.520, Seattle, WA 98105 | 2019-07-08 |
| 1114580396 | Christina Beck | Surgery | 325 9th Ave, Seattle, WA 98104 | 2019-04-15 |
| 1356760664 | Stephen Lee Viviano | Surgery | 1959 Ne Pacific St, Seattle, WA 98195-2425 | 2014-04-15 |
| 1447592282 | Howard Wang | Surgery | 4800 Sand Point Way Ne, Seattle, WA 98105-3901 | 2013-03-19 |
| 1982970513 | Eugene Oh | Surgery | 1550 N 115th St, Seattle, WA 98133 | 2012-03-28 |
| 1134435787 | William P Schmitt | Surgery | 1100 9th Ave, Seattle, WA 98101-2756 | 2010-08-20 |
| 1225342991 | Shannon Margaret Colohan | Surgery | 1959 Ne Pacific St, Uwmc Division of Plastic Surgery, Seattle, WA 98195-0001 | 2010-08-04 |
| 1073835427 | Downey Plastic Surgery Tr | Surgery | 1536 N 115th St, Suite 105, Seattle, WA 98133-8400 | 2010-02-25 |
| 1548402308 | Janelle Dubbins Sousa | Surgery | 1959 Ne Pacific St, Box 356410, Seattle, WA 98195-0001 | 2009-03-25 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.