Provider Demographics
NPI:1053392597
Name:GRETCH, GARY JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:JOSEPH
Last Name:GRETCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2620 WHEATON WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3319
Mailing Address - Country:US
Mailing Address - Phone:360-377-3923
Mailing Address - Fax:360-373-4988
Practice Address - Street 1:2620 WHEATON WAY
Practice Address - Street 2:STE 1
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3335
Practice Address - Country:US
Practice Address - Phone:360-377-3923
Practice Address - Fax:360-373-4988
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028724207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1067537Medicaid
G8885139Medicare PIN
WA1067537Medicaid
G115143903Medicare PIN