Benjamin, Gary Gordon
Benjamin, Gary Gordon is an individual health care provider with primary practice located at 1304 Fawcett Ave Ste 100 , Tacoma WA 98402-1900. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology. Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology is his primary health care specialty. Benjamin, Gary Gordon can be contacted via phone (253) 761-4200.Contact Information
Primary practice address
1304 Fawcett Ave Ste 100
Tacoma WA 98402-1900
Phone: (253) 761-4200
Fax: (253) 761-4201
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | MD00034148 | Washington |
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | MD21111 | Oregon |
| Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology | 2085R0204X | MD00034148 | Washington |
| Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology | 2085R0204X | MD21111 | Oregon |
Profile Details
| NPI number | 1164595286 |
|---|---|
| LBN Legal business name | Benjamin, Gary Gordon |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 16th, 2006 |
| Last updated | May 13th, 2019 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1164595286 | NPPES |
| Washington | Other | 0372658 | L&I-DIAGNOSTIC IMAGING NW |
| Washington | Other | 0127162 | L&I-DIAGNOSTIC IMAGING NW |
| Washington | MEDICAID | 500670859 | L&I-DIAGNOSTIC IMAGING NW |
| Washington | MEDICAID | 1031136 | L&I-DIAGNOSTIC IMAGING NW |
| Washington | Other | 0186167 | L&I-DIAGNOSTIC IMAGING NW |
| Washington | Other | 0335999 | L&I-DIAGNOSTIC IMAGING NW |
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