Basic Information
| Provider Information | |||||||||
| NPI: | 1023073798 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GYFT CLINIC, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8550 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984190550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534755433 | ||||||||
| FaxNumber: | 2534736715 | ||||||||
| Practice Location | |||||||||
| Address1: | 2201 SOUTH 19TH STREET | ||||||||
| Address2: | STE #101 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2554755433 | ||||||||
| FaxNumber: | 2534736715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 02/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | MCLEES | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | Z | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 2534755433 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 7020613 | 05 | WA | MEDICAID |