Provider Demographics
NPI:1174599369
Name:GLEYZER, ELENA ALEX
Entity type:Individual
Prefix:DR
First Name:ELENA
Middle Name:ALEX
Last Name:GLEYZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YELENA
Other - Middle Name:
Other - Last Name:FRID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9601 STEILACOOM BLVD SW
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98498-7213
Mailing Address - Country:US
Mailing Address - Phone:253-582-8900
Mailing Address - Fax:253-756-2879
Practice Address - Street 1:9601 STEILACOOM BLVD SW
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98498-7213
Practice Address - Country:US
Practice Address - Phone:253-582-8900
Practice Address - Fax:253-756-2879
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035344207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB24093Medicare PIN
WAH40852Medicare UPIN