Gary Fudem, M.D.

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

MD60484351 Issued in WA

Practice address

325 9TH Ave
Department of Plastic & Reconstructive Surgery
Seattle, WA 98104-2420

Phone

(206) 744-5735

NPI assigned

Dec 1, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Umass Memorial Medical Group Inc

  • Internal Medicine Physician
  • Worcester, MA
  • NPI 1760445373
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418774400000",
    "number": "1336123454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50095",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981455095",
            "telephone_number": "206-543-6420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 9TH AVE",
            "address_2": "DEPARTMENT OF PLASTIC & RECONSTRUCTIVE SURGERY",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981042420",
            "telephone_number": "206-744-5735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUDEM",
        "first_name": "GARY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2014-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "WA",
            "license": "MD60484351",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336123454",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jonathan Lee Fu, MD
• Justin Jeng-Young Fu, MD
• Tianyuan Fu, MD
• Esther Fuchs, M.D.
• Gina Marie Fudacz
• Fuel Spine & Sports Therapy
• Jose Fuente
• Jennifer D Fuentes, LMHC
• Molly Marie Fuentes, M.D.
• Myrvie Fuentes

• Plastic and Reconstructive Surgery Physician in Seattle, WA
• Providers in Seattle, WA by specialty
• Plastic and Reconstructive Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.