Provider Demographics
NPI:1356705669
Name:GORBATY, JACOB (MD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:GORBATY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:JACOB
Other - Middle Name:D
Other - Last Name:GORBATY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11307 BRIDGEPORT WAY SW STE 220A
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3024
Mailing Address - Country:US
Mailing Address - Phone:253-985-6675
Mailing Address - Fax:253-985-6678
Practice Address - Street 1:11307 BRIDGEPORT WAY SW STE 220A
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3024
Practice Address - Country:US
Practice Address - Phone:253-985-6675
Practice Address - Fax:253-985-6678
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC218845207X00000X
WAMD61266815207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2207992Medicaid