Provider Demographics
NPI:1548346356
Name:GILLESPY, THURMAN III (MD)
Entity type:Individual
Prefix:
First Name:THURMAN
Middle Name:
Last Name:GILLESPY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24147
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0147
Mailing Address - Country:US
Mailing Address - Phone:206-292-6233
Mailing Address - Fax:206-292-7764
Practice Address - Street 1:1229 MADISON ST
Practice Address - Street 2:SUITE 900
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3586
Practice Address - Country:US
Practice Address - Phone:206-292-6233
Practice Address - Fax:206-292-7764
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000278192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0295832OtherL&I FOR WENATCHEE VALLEY MEDICAL CENTER
8990OtherINTERNAL ID-MOTOR VEHICLE ID
WA8121766Medicaid
D65413Medicare UPIN
WA8121766Medicaid
WA8864960Medicare PIN