Provider Demographics
NPI:1548451099
Name:NIXON, GARY STEPHEN (LMP)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:STEPHEN
Last Name:NIXON
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10622 SE CARR RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5406
Mailing Address - Country:US
Mailing Address - Phone:425-277-2225
Mailing Address - Fax:425-277-1591
Practice Address - Street 1:10622 SE CARR RD
Practice Address - Street 2:SUITE A
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5406
Practice Address - Country:US
Practice Address - Phone:425-277-2225
Practice Address - Fax:425-277-1591
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009778174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist