Doctor Name: | MR. GREGORY (NMI) SCHALLER |
NPI Number: | 1740206622 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MPA, PA-C |
License Number: | PA10004999 |
Business Practice Address: | 208 Cedar Creek Terrace Ione, WA - 99139 |
Business Phone Number: | 5094423514 |
Business Fax Number: | 5094423436 |
Mailing Address: | 208 Cedar Creek Terrace, Po Box 197 IONE |
State: | WA |
Postal Code: | 99139 |
Phone Number: | 5094423514 |
Fax Number: | 5094423436 |
NPI Enumeration Date: | 07/14/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA10004999 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |