Basic Information
| Provider Information | |||||||||
| NPI: | 1396735437 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHILLHAMMER | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 309 | ||||||||
| Address2: | |||||||||
| City: | DARRINGTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982410309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604361055 | ||||||||
| FaxNumber: | 3604360146 | ||||||||
| Practice Location | |||||||||
| Address1: | 1190 RIDDLE ST | ||||||||
| Address2: | |||||||||
| City: | DARRINGTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604361055 | ||||||||
| FaxNumber: | 3604360146 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2005 | ||||||||
| LastUpdateDate: | 12/27/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00021477 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7108020 | 05 | WA | MEDICAID |